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D E C E M B E R , 2 0 1 8

OFFICE OF THE AUDITOR GENERAL

T H E R E P U B L I C O F U G A N D A

www.oag.go.ug | E-mail: [email protected]

A VALUE FOR MONEY AUDIT REPORT ON BUDGETPERFORMANCE BY SELECTED HEALTH

SECTOR INSTITUTIONS

A REPORT BY THE AUDITOR GENERAL

A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions

A Report by the Auditor General

December, 2018

T H E R E P U B L I C O F U G A N D A

AUDITOR GENERAL’S MESSAGE

24th December 2018

The Rt. Hon. Speaker of Parliament

Parliament of Uganda

Kampala.

VALUE FOR MONEY AUDIT REPORT ON BUDGET PERFORMANCE BY SELECTED HEALTH SECTOR

INSTITUTIONS

In accordance with Article 163(3) of the Constitution, I hereby submit my report on Budget Performance by

Selected Health Sector Institutions.

My office intends to carry out a follow-up at an appropriate time regarding actions taken in relation to the

recommendations in this report.

I would like to thank my staff who undertook this audit and the staff of the selected Health Sector Institutions

for the assistance offered to my staff during the period of the audit.

John F.S. Muwanga

AUDITOR GENERAL

IA Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General

TABLE OF CONTENTS

LIST OF TABLES................................................................................................................................................II ABBREVIATIONS...............................................................................................................................................III

EXECUTIVE SUMMARY.....................................................................................................................................IV

CHAPTER ONE...................................................................................................................................................1INTRODUCTION.................................................................................................................................................21.1 BACKGROUND TO THE STUDY...............................................................................................................21.2 MOTIVATION..........................................................................................................................................21.3 DESCRIPTION OF THE AUDIT AREA.....................................................................................................31.4 AUDIT OBJECTIVE.................................................................................................................................51.5 AUDIT SCOPE.........................................................................................................................................5

CHAPTER TWO..................................................................................................................................................6AUDIT METHODOLOGY.....................................................................................................................................72.1 SAMPLING............................................................................................................................................72.2 DATA COLLECTION................................................................................................................................72.3 DATA ANALYSIS.....................................................................................................................................8

CHAPTER THREE...............................................................................................................................................9SYSTEMS AND PROCESS DESCRIPTION.........................................................................................................103.1 ROLES AND RESPONSIBILITIES OF KEY PLAYERS............................................................................103.2 PROCESS DESCRIPTION......................................................................................................................11

CHAPTER FOUR...............................................................................................................................................12FINDINGS, CONCLUSIONS AND RECOMMENDATIONS...................................................................................134.1 EXTENT OF DELIVERY OF PLANNED OUTPUTS..................................................................................144.2 PLANNING AND BUDGETING.............................................................................................................204.3 RELEASE/DISBURSEMENT PERFORMANCE.....................................................................................234.4 UTILIZATION / ABSORPTION OF FUNDS............................................................................................264.5 MONITORING AND EVALUATION........................................................................................................29

GLOSSARY OF KEY TERMS...............................................................................................................................32APPENDICES...................................................................................................................................................33APPENDIX I: Macro structure of the Health Sector.........................................................................................33APPENDIX II: Selected Entities, Programmes and Sub Programmes.............................................................34APPENDIX III: Documents Reviewed..............................................................................................................37APPENDIX IV: Interviews Conducted................................................................................................................38APPENDIX V: Showing extent of delivery of Planned Outputs.........................................................................39APPENDIX VI: Showing details of funds diverted by Selected Health Sector Institutions..............................52APPENDIX VII: Showing duration of the Procurement Process.......................................................................64APPENDIX VIII: Showing inconsistencies in reporting among Selected Health Sector Institutions...............65

II A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General

LIST OF TABLES

Table 1: Showing the Total budget vs Actual Expenditure for the 8 selected health sector entities

FY 2017/18..........................................................................................................................................................5

Table 2: Showing extent of delivery of sampled planned outputs by selected entities...................................14

Table 3: Showing reasons for partially achieved outputs by selected health sector institutions...................15

Table 4: Showing reasons for non-implementation of the planned outputs...................................................18

Table 5: Showing outputs without targets and performance indicators.........................................................20

Table 6: Summary of Selected Health Sector and MDA Compliance Assessment (%)...................................21

Table 7: Showing inconsistencies between the MPS FY 17/18 and the approved budget estimates...............22

Table 8: Showing Release performance for Selected Health Sector Entities FY 2017/18...............................23

Table 9: Showing percentage release of external financing Vs GoU counterpart funding.............................24

Table 10: Showing Unreleased funds on sampled outputs under MoH..........................................................24

Table 11: Showing Health Sector approved budget absorption rates FY 2017/18...........................................26

Table 12: Showing Funds Re-Allocation for a selection of outputs.................................................................27

Table 13: Showing funds diverted from the planned sampled outputs...........................................................28

Table 14: Detailing the time required for different activities of the procurement process.............................29

IIIA Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General

ABBREVIATIONS

MOH Ministry of Health

HSSIP Health Sector Strategic and Investment Plan

RRH Regional Referral Hospital

UBTS Uganda Blood Transfusion services

GoU Government of Uganda

MDAs Ministries Departments and Agencies

MFPED Ministry of Finance Planning and Economic Development

BMAU Budget Monitoring and Accountability Unit

NPA National planning Authority

UGX Uganda Shillings

NRH National Referral Hospital

BFP Budget Framework Paper

Bn Billion

FY Financial Year

MPS Ministerial Policy Statement

DGHS Director General of Health Services

IFMIS Integrated Financial Management Informantion System

NRH National Referral Hospital

IV A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General

The health sector is one of the priority sectors of government that is critical in the attainment of Uganda Vision 2040 by producing a healthy and productive population that effectively contributes to socio-economic growth. The sector comprises a number of spending agencies (votes) namely; The Ministry of Health (Vote 014), National Medical Stores (Vote 116), Uganda Cancer Institute (Vote 114); Uganda Heart Institute (Vote 115); Uganda Blood Transfusion Service (Vote 151); Uganda Aids Commission (Vote 107), Health Service Commission (Vote 134), Mulago National Referral Hospital (Votes 161), Butabika National Mental Referral Hospital (Vote 162), 14 Regional Referral Hospitals (Votes 163 – 176), National Drug Authority, Joint Clinical Research Centre, Uganda Virus Research Institute, Uganda National Research Health Organization and Regulatory Councils, i.e. Uganda Medical and Dental Practitioners Council, Uganda Nurses and Midwives Council and Allied Health Practitioners Council.

Ministry of Health is the central agency in charge of policy analysis and formulation, strategic planning, provision of nationally coordinated services that include emergency preparedness, health research, and monitoring and evaluation of the overall health sector performance. The Health Sector Development Plan points out that, in terms of planning, there is a major shortcoming where health sector targets and activities are set without the requisite costing of activities and allocation of required resources to meet them. Also, priorities are not adequately set, which makes it difficult to implement plans in resource constrained situations. The Government of Uganda has steadily increased its budget allocation of funds to the health sector; however, it continues to allocate less than 10% of its budget to health care, which is less than the 15% agreed in the Abuja Declaration by heads of African states. The current funding of US$ 27 per capita per annum expenditure on health care is far below the US$ 44 per capita recommended1. Due to the resource constraints it is imperative that the available resources are utilized effectively to deliver on the health sector objectives.

The Office of the Auditor General undertook a value for money audit to assess the extent of delivery of planned outputs of eight (8) selected entities in the health sector in the financial year 2017/2018. The eight entities comprised of Ministry of Health, Mulago National Referral Hospital Complex, Uganda Blood Transfusion Services, Mbarara Regional Referral Hospital, Gulu Regional Referral Hospital, Mbale Regional Referral Hospital, Masaka Regional Referral Hospital and Fort Portal Regional Referral Hospital.

KEY AUDIT FINDINGSa) Extent of delivery of planned outputsIt was observed that out of the 52 sampled planned outputs in the 8 selected health sector entities, 14 outputs (27%) were fully achieved, 18 were partially achieved (34.6%) and 11 outputs were not implemented at all (21.2%). The extent of delivery for 9 (constituting 17.3%) of the planned outputs could not be assessed, because there were no performance targets and indicators set for the outputs. MoH which is the largest player in the sector was able to achieve 26% of its planned outputs; for the rest of the entities, the level of achievement ranged from 16.6% to 50%.

For the 18 outputs that were patially achieved under various entities, the major contributing factors for partial achievement were procurement delays, budget shortfalls, delayed release of funds and diversion of funds.

1 World Health Organization Profiles, http://www.aho.afro.who.int/profiles_information/index.php/uganda:health_ financing_system

EXECUTIVE SUMMARY

VA Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General

b) Planning and BudgetingReview of the certificate of compliance of the annual budget 2017/18 assessment report by National Planning Authority (NPA) indicated that the Health sector is 51.7 percent compliant. Specifically, the sector performed at 88%, 38.1%, 67.6% and 37.3% at planning, project implementation, budget process instruments (BFP and AB) and annual budget performance, respectively. The performance was on account of low budget absorption by the majority of health sector institutions especially under projects.

In terms of strategic planning, the sector is doing well as six (6) out of the eight (8) selected entities had approved strategic plans. Also available is the approved health sector development plan which is aligned to the NDPII. However, Mulago Hospital Complex and Fort Portal RRH scored 0% at planning on account of not having approved strategic plans. It was also observed that under MoH there were a number of projects under implementation which were not among the interventions proposed in the NDPII.

c) Release/ Funds disbursement performanceDuring the FY 2017/2018, out of the total UGX 1.95 trillion allocated to the Health Sector, UGX 1.28 trillion which represents 66% was released. All votes received about 100% of the budget except MoH which received only 36%. For the eight (8) selected entities it was observed that overall, 55.6% of the approved budget was realized by the entities. Most of the entities received their entire budgetary allocations except MoH. For MoH, the shortfall was caused by low disbursement performance from external financing.

In terms of counterpart funding, it was observed that government released all the expected counterpart funding contributions on all the externally funded projects. Due to the poor release performance especially by MoH, a number of outputs and targets were either not implemented or partially implemented.

d) Utilization/ Absorption of funds Out of the total release of UGX 1.28 trillion, the health sector spent a total of UGX 1.191 trillion representing 93.04% of the released amount. For the 8 selected entities, the analysis showed that the entities spent 79% of the amount released. The unutilized funds (UGX 99.4 billion) were mainly funds earmarked for pension, gratuity and social contribution and construction projects among others. Failure to absorb funds was attributed to procurement delays and delayed verification of decentralised pensioners in Regional Referral Hospitals.

Further analysis of the performance of the selected outputs revealed that in addition to poor release performance, the delivery of the expected outputs was affected by budget variations such as reallocations, diversion/ mischarge of funds and delays in procurement. The analysis showed that for the eight (8) selected entities, on average over 50% (UGX 28 billion) of the funds released for the selected sub programs (outputs) were not spent on the planned outputs. This impacted on the achievement of the planned outputs. The Accounting Officers attributed this to resource constraints imposed by the MTEF limits issued by Ministry of Finance and the priority demands entities have to meet even where resources are not forthcoming.

e) Utilization/ Absorption of funds From the interviews held with project coordinators, heads of departments and Accounting Officers in the selected entities, the audit team established that there were no specific monitoring and evaluation work plans with clear set targets and indicators to facilitate monitoring of planned activities for the programs and projects selected for review.

VI A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General

It was further noted through review of the expenditure files that although funds amounting to UGX. 1,287,353,819 were spent on monitoring and evaluation of projects and programs, there were no specific monitoring and evaluation reports on file to confirm that the expected monitoring and evaluation activities were carried out and recommendations made for corrective action.

f) Utilization/ Absorption of funds Review of the annual work plans, approved budget estimates and the 4th quarter cumulative performance reports indicated that in all the selected health sector institutions, there were some errors and inconsistencies in reporting on the delivery of outputs and in some instances there was no relationship between the planned outputs and the actual reported achievements. Also the revised approved budget figures in the Ministerial Policy Statements and cumulative vote performance reports were at variance with the actual revised budgeted figures captured in the IFMS.

KEY RECOMMENDATIONSa) The sector should strive to always give priority to the proposed NDPII health sector interventions and targets during planning and budgeting. The tendency to take on new projects outside NDPII projects should be restrained or undertaken in accordance with the national planning framework.

b) The Ministry should work closely with stakeholders to ensure that program activities are properly planned to facilitate timely disbursement of funds.

c) Accounting Officers should adhere to the approved budgetary allocations and work plans. Where inevitable, budget variations should be undertaken in accordance with the established procedures.

d) The sector should set realistic targets with clear performance indicators during planning and endeavour to revise the targets in case of low budget outturn caused by poor commitment from donors/Government to release all the funds as planned and in a timely manner.

e) The sector should constitute M&E units to properly monitor implementation of activities, consolidate all the reports generated from the individual Programme/project monitoring teams/ committees and follow up recommended corrective actions. In addition, the established units should ensure that specific M&E plans are developed with clear indicators and targets for assessing performance and ensure availability of accurate and timely information on health sector performance.

f) The sector should ensure that the performance is accurately reported to inform appropriate government policy actions.

OVERALL AUDIT CONCLUSIONOverall, the selected eight (8) entities in the sector partially achieved their expected planned outputs for the year. The delivery of the expected outputs and targets was affected by challenges in planning, budget shortfalls, funds absorption, procurement delays and budget variations among others.

To improve on the output delivery, it is important that the existing challenges in monitoring and evaluation are also addressed to ensure corrective action and accurate information for decision making.

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2 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General

2 Health Sector Budget Framework paper 2018/2019, page 6

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND TO THE STUDYThe health sector is one of the priority sectors of government that is critical in the attainment of Uganda Vision 2040 by producing a healthy and productive population that effectively contributes to socio-economic growth. The sector comprises a number of spending agencies (votes); The Ministry of Health (Vote 014), National Medical Stores (Vote 116), Uganda Cancer Institute (Vote 114); Uganda Heart Institute (Vote 115); Uganda Blood Transfusion Service (Vote 151); Uganda Aids Commission (Vote 107), Health Service Commission (Vote 134), Mulago National Referral Hospital (Votes 161), Butabika National Mental Referral Hospital (162), 14 Regional Referral Hospitals (Votes 163 – 176) National Drug Authority, Joint Clinical Research Centre, Uganda Virus Research Institute, Uganda National Research Health Organization and regulatory councils, i.e. Uganda Medical and Dental Practitioners Council, Uganda Nurses and Midwives Council and Allied Health Practitioners Council.

Ministry of Health is the central agency in charge of policy analysis and formulation, strategic planning, provision of nationally coordinated services that include emergency preparedness, health research, and monitoring and evaluation of the overall health sector performance.

The Health Sector Priorities for the financial year 2017/2018 were as follows:a) Scale up Public Health Interventions to address the high burden of preventable diseases in our country. i) Scaling up of Health promotion, education and effective communication to the population. ii) Scaling up interventions to address the high burden of HIV/TB, Malaria, Nutritional challenges, Environmental

Sanitation and Hygiene, Immunization, Hepatitis B and Non-Communicable Diseases.

b) Introduce Community Health Extension Workers (CHEW’s) to educate the communities on the prevention of diseases and link the communities to the Health services.

c) Improvement of Reproductive, Maternal, Neonatal, Child and Adolescent health services to reduce mortality and morbidity and improve their health status.

d) Human resources (attraction, motivation, retention, training and development). Mobilize additional resources for recruitment and incentives.

e) Infrastructural developments; constructions, rehabilitation and remodelling focusing mainly on HCIIIs, HCIVs and Districts with special needs like islands, difficult to reach areas, large populations and socio-demographic peculiarities.

f) Mobilization of additional resources for medicines and health supplies especially laboratory supplies, reagents and Blood collection supplies.

e) Effective and well-structured Support Supervision to the Local Governments and strengthened regulatory authorities and professional councils in the Health sector.

1.2 MOTIVATIONOverall objective no. 3 of the NDP II emphasises the role of the health sector in contributing towards the production of a healthy human capital for wealth creation through the provision of equitable, safe and sustainable health services.2

3A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General

3 Health Sector Strategic and investment Plan (2010/11–2014/15) Page 504 World Health Organization Profiles, http://www.aho.afro.who.int/profiles_information/index.php/uganda:health_ financing_system5 HSSIP 2010/11 – 2014/15 page 25

The Health sector development plan points out that, in terms of planning, there is a major shortcoming where health sector targets and activities are set without the requisite costing of activities and allocation of required resources to meet them. Also, priorities are not adequately set, which makes it difficult to implement plans in resource-constrained situations.

The Health Sector Strategic and Investment Plan (2010/11 – 2014/15) identified budgeting challenges which include but not limited to the following; inadequate resources for curative and preventive medicines, remuneration of health workers is very low and has not created sufficient motivation to attract qualified health workers to work in hard to reach areas, investments for basic infrastructures have not met the need for quality service provision in the health facilities and growth of essential medicines budget is not in line with the increasing needs for medicines of the population3.

The Government of Uganda has steadily increased its budget allocation of funds to the health sector. However, it continues to allocate less than 10% of its budget to health care, which is less than the 15% agreed in the Abuja Declaration by heads of African states. The current funding of US$ 27 per capita per annum expenditure on health care is far below the US$ 44 per capita recommended4. In the year 2017/18, Government allocated UGX1.95 trillion to the health sector. Due to the resource constraints, resources earmarked for health sector should be utilized effectively to ensure achievement of the sector objectives.

It is against this background that the Office of the Auditor General decided to undertake a value for money audit to assess the extent to which the health sector is achieving planned objectives in the employment of available resources.

1.3 DESCRIPTION OF THE AUDIT AREA1.3.1 General DescriptionThe provision of health services in Uganda is decentralised with districts and health sub-districts (HSDs) playing a vital role in the delivery and management of health services at those levels. The health services are structured into National Referral Hospitals (NRHs) and Regional Referral Hospitals (RRHs), General Hospitals, Health Centre (HC) IVs, HC IIIs, HC IIs and Village Health Teams (HC Is).

The health care delivery system in Uganda is organised in tiers, from the Village Health Teams (VHTs) to general hospitals. The national and regional referral hospitals are semi-autonomous institutions, while the district health services, general hospitals and lower level health centres are managed by LGs.

Several functions have been delegated to national autonomous institutions including Uganda Cancer Institute, Uganda Heart Institute, Uganda Blood Transfusion Services, Uganda Virus Research Institute, National Medical Stores, Central Public Health Laboratories, Professional Councils, National Drug Authority (NDA) and research institutions, Uganda National Health Research Organization (UNHRO), Uganda Natural Chemotherapeutic Research Laboratory. The Health Service Commission (HSC), and the Uganda AIDS Commission (UAC)5.


6 Ministry of Health Strategic Plan 2015/2016-2019/20207 Health sector development plan 2015/16 - 2019/20 Page 488 Health sector development plan 2015/16 - 2019/20 Page 489 Health sector development plan 2015/16 - 2019/20 Page 4810 NDP II page 190, Health sector Strategic Plan 2015/16-2019/20 page 37 and Health Sector Development plan 2015/16-2019/20 page 48.

1.3.2 Legal Framework for the Health sector6 The Health sector provides services in line with the Constitution of the Republic of Uganda (1995 as amended) and the LG Act (1997) which decentralised governance and service delivery.

The Sector Affiliated autonomous institutions were established by Acts of Parliament; UNHRO was established through the UNHRO Act, 2011, UAC was established by the Parliamentary statute no. 2 of 1992, NMS was established by the NMS Act 1993, the NDA was established in 1993 by the National Drug Policy and Authority Statute which in 2000 became the National Drug Policy and Authority (NDP/A) Act, Cap.206 of the Laws of Uganda (2000 Edition).

1.3.3 Health sector Mandate7

‘‘To accelerate movement towards Universal Health Coverage with essential health and related services needed for promotion of a healthy and productive life.’’

Health sector Vision8

‘‘To have a healthy and productive population that contributes to economic growth and national development.’’

Health sector Mission9

‘‘To facilitate the attainment of a good standard of health by all people of Uganda in order to promote a healthy and productive life.’’

1.3.4 Objectives of the Health SectorThe major objectives of the sector over the NDPII period are10: i)Contribute to the production of healthy human capital through provision of equitable, safe and sustainable health services.ii)Increase financial risk protection of households against impoverishment due to health expenditures Address the key determinants of health through Strengthening inter-sectoral collaboration and partnerships.

iii)Enhance health sector competitiveness in the region, including establishing centres of excellence in heart, cancer, renal care domains; and diagnostic services.

1.3.5 Activities of the Health SectorRegarding the development and maintenance of the National Health System over the Sector Development Plan period, the MoH is responsible for: a) Governance and Leadership. i) Policy formulation and dialogue. ii) Collaboration with all stakeholders. iii) Coordination of health programs. iv) Ensuring transparency and accountability. b) Strategic planning, resource mobilisation and budgeting.c) Setting regulations, standards and guidelines development and dissemination.d) Supervision, Monitoring and evaluation of the overall sector performance. e) Human resource capacity development and technical support. f) Infrastructure development.

1.3.6 Organizational Structure for the Health SectorThe key oversight functions of the health sector are managed through the Minister and the Ministers of State. The sector head is the Minister for Health who is assisted by two ministers of state (Minister of State for Health General Duties-MoSH GD and Minister of State for Health Primary Health Care-MoSH PHC); The Permanent Secretary who coordinates resources for effective management of Health Funds; The Director General of Health Services (DGHS) who coordinates technical functions for delivery of Health services; The work of the DGHS is coordinated through four (4) directorates: Directorate for Strategy, Policy & Development and Directorate of Curative Services, Directorate of Public Health and Directorate of Health Governance and Regulation and 20 departments.


The sector also has 16 medical directors in the national and regional referral hospitals as well as 14 Executive Directors of semi-autonomous agencies who complement the work of the Ministry in discharging its core functions through service delivery, research, training, procurement and distribution of drugs. The detailed organogram for the sector is shown in Appendix I.

1.3.7 FundingIn the FY 2017/2018, the allocation to the health sector was 6.4% of the total National Budget. The Budget for the Health sector increased from UGX 1.87 trillion in FY 2016/2017 to UGX 1.95 trillion in the FY 2017/2018. During the year under review the Health sector benefited from supplementary budgets in favour of National Medical Store, Uganda Cancer Institute, Mulago Hospital Complex and Ministry of Health. Below are the budgetary allocations and releases in Billions to the eight (8) selected health sector entities during the FY 2017/201811.

Table 1: Showing the Total budget vs Actual Expenditure for the 8 selected health sector entities FY 2017/18

ENTITY/ MDA’s Budgeted Actual Spent Variance (A-B)

Recurrent Development Total Budget

(A)

Rec’t Development Total Actual

(B)GoU Dev’t

Donor Dev’t

GoU Dev’t Donor Dev’t

MOH 64.48 28.84 878.41 971.73 57.32 31.77 209.52 298.62 673.11

UBTS 12.70 0.36 0.00 13.06 12.37 0.35 0 12.72 0.34

Mulago NRH 45.00 22.02 0 67.02 41.59 22.02 0 63.61 3.41

Gulu RRH 5.46 1.49 0 6.95 4.65 1.49 0 6.14 0.81

Mbarara RRH 4.79 1.98 0 6.77 4.36 1.87 0 6.24 0.53

Mbale RRH 6.94 3.06 0 9.99 6.69 3.06 0 9.74 0.25

Fort Portal RRH 5.28 1.06 0 6.35 4.43 1.06 0 5.49 0.86

Masaka RRH 4.33 2.06 0 6.38 4.01 2.06 0 6.07 0.31

TOTAL 148.98 60.87 878.41 1088.25 135.42 63.68 209.52 408.63 679.62

Source: OAG analysis of the approved budget estimates 17/18 and cumulative 4th quarter vote performance report 2018

Note: The total funding excludes appropriation in aid (AIA) and arrears.

1.4 AUDIT OBJECTIVEThe objective of the audit was to assess the extent of delivery of planned outputs in the eight (8) selected Health Sector entities during the year 2017/18. This was done through an evaluation of the processes of planning and budgeting, release of funds, Utilization of funds, monitoring and evaluation, and performance reporting.

1.4.1 Audit Questionsi. Is the sector plan linked to the National Development Plan II?ii. Are the set targets realistic and consistent?iii. Were the budgeted funds realized as planned and in a timely manner?iv. Where the released funds utilized for the intended purpose? v. Are the priority projects properly monitored and evaluated?vi. Are achieved results accurately reported?

1.5 AUDIT SCOPEThe audit focused on budget performance by the selected Health sector institutions. The study covered financial 2017/2018. For purposes of this audit, a selected sample of outputs of both capital development and recurrent nature were assessed and details are in Appendix II.

11 Approved budget estimates FY 2017/2018 Pages 30, 32

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AUDIT METHODOLOGY

The audit was carried out in accordance with the International Organisation of Supreme Audit Institutions (INTOSAI) standards and guidelines. The standards require that the audit is planned in a manner which ensures that an audit of high quality is carried out in an economic, efficient and effective way and in a timely manner.

The study relied upon document review, interviews and inspection to obtain relevant information to answer the audit questions. Data was collected from several government agencies and other key players in the health sector based on their role in budget implementation and monitoring of activities.

2.1 SAMPLINGSampling materiality was considered in the context of quantitative and qualitative factors such as relative magnitude, the nature and extent of the effect of these factors on the evaluation or measurement of the subject matter, and the interest of the intended stakeholders.

The selection of the sample of MDAs in the health sector was guided by the following; entities within and above 90% of the cumulative total health sector budget were selected. The selection of some regional referral hospitals was premised on the fact that these referrals, serve a relatively large population. Within the selected entities, the selection of the programmes was based on order of importance and link to the strategic plan and the national development plan, all Programmes with a budget of at least 25% of the selected entity’s total budget were picked for the assessment and other programmes were selected based on each entity’s capital development budget.

All outputs of a capital development nature under the respective sub programmes or projects were selected; outputs of a recurrent nature were also selected on the basis of budget significance or size in terms of monetary value and their importance in terms of achievement of the strategic sector objectives. The audit team also applied professional judgement when selecting other outputs of a recurrent nature where it was deemed appropriate. Entities, programmes, sub programmes and outputs sampled are attached in Appendix II.

2.2 DATA COLLECTIONThe data collection tool was designed basing on the key process points (Planning and Budgeting, Release of Funds, Utilization of funds, Monitoring and Evaluation, and Performance reporting) with risk indicators, key out puts for assessment among other parameters. The tool was used together with other data collection methods which include the following;

Methodology to establish whether the Sector Plan is linked to the National Development Plan IIThe Audit team reviewed the current sector development plan 2015/16-2019/20, the NDP II 2015/16-2019/20, approved MOH strategic plan 2015/2016-2019/2020, Annual work plans 2017/18, , MPS for F/Y 2017/18, MFPED budget documents including the Budget Speech, and approved estimates 17/18, BFP 2017/18 to establish linkage between the planning and budgeting documents, accuracy and consistency of the set targets. The Second National Health policy was also reviewed in order to gain an in-depth understanding of the legal and regulatory framework for the sector.

CHAPTER TWO


Methodology to establish whether the Budgeted Funds were realized as planned and in a timely mannerApproved budgets were reviewed against the actual receipts from GoU and development partners to establish whether funds were released and received as planned, Budget analysis reports (BIG Reports) were also reviewed to ascertain the timing of released of funds from GoU, Bank statements for donor funded projects were obtained to ascertain the timing of the donor disbursements.

Methodology to establish whether the Released Funds were utilized for the intended purpose Payment files were analysed against the approved budgets and Work plans to ascertain if the funds released were spent on the actual outputs planned, and if the expenditure on the planned out puts was correctly charged according to the GoU chart of accounts. The payment files were further analysed against the Budget analysis reports to ascertain if the excess expenditure on planned outputs had approved reallocations or supplementary provisions. Interviews were held with the Ministry of Health departmental heads of the different programmes/ Departments, Project coordinators, Hospital directors of national and regional referrals to establish their roles and responsibilities as well as challenges they face in budget execution.

Methodology to establish whether the Priority Projects were properly monitored and evaluatedMonitoring and Evaluation plans were reviewed to ascertain wether monitoring activities were planned and budgeted for, and also ascertain wether the monitoring and evaluation parameters were realistic and in line with the MoH monitoring and evaluation framework. The Lead Agency (MoH) was also interviewed to establish how they were involved in ensuring that recommendations from monitoring were implemented by other institutions in the health sector.

Methodology to establish whether the Achieved Results were accurately reportedThe audit team reviewed quarterly performance reports 2017/2018, Health Sector Annual Performance Report 2017/18, the Government Annual Performance Report (GAPR 2017/2018), and conducted physical inspections to draw a comparision between the actual reported out puts and what is actually on ground to be able to conclude on the accuracy of the reported out puts. The team interviewed the project coordinators, project managers and the MoH officers in the planning department to ascertain the causes for any discrepancies. Details of documents reviewed and interviews conducted are detailed in Appendix III and IV.

2.3 DATA ANALYSISTo support the findings and conclusions, both qualitative and quantitative data was analysed. This was done to establish relationships and in some cases to explain certain observations. Qualitative data collected was summarized such as objectives, planned activities and actual outputs both recurrent and capital development in nature. These were grouped and compared in order to establish their link to the overall strategic objectives of the sector, relate findings and their causes, while quantitative data such as, number of patients served by each regional referral, budget amounts, actual receipts, and total expenditure was used to establish the level of absorption and performance.

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SYSTEMS AND PROCESS DESCRIPTION

3.1 ROLES AND RESPONSIBILITIES OF KEY PLAYERSENTITY/PLAYER KEY ROLES AND RESPONSIBILITIES

Parliament of Uganda (Health Committee) • Passing policies and laws• Resource allocation • Advocacy for health • Performance monitoring

National Drug Authority • Oversight, regulation and management of health products • Participation in MoH planning, monitoring and review

National Medical Stores • Management of procurement, warehousing and distribution of all health products• Participation in MoH planning, monitoring and review

Uganda Blood Transfusion Services • Coordination of provision of blood and blood products • Participation in MoH planning, monitoring and review

National and RRHs • Implementation of the MoH policies and guidelines • Participation in policy and strategy formulation and review • Participation in support supervision to LGs • Participation in performance reviews

Ministry of Finance, Planning and Economic Development

• Provision of adequate financial resources for implementation of the Strategic Plan• Provide data that is required to inform health planning (e.g. UDHS, Household surveys, vital statistics) • Participation in development policies and strategies • Project appraisals• Joint planning, monitoring and review of sector performance

Development Partners • Provision of demand-driven technical assistance and inputs into the implementation of the MoH priorities• Complement financing of the MoH priorities with earmarked or unearmarked funds • Actively participate in joint sector planning, monitoring and review

National Monitoring and Evaluation Working Group

• Maintains a monitoring and evaluation function within the SWG secretariat to coordinate MDA and LG monitoring as it pertains to Sector results, and for upwards reporting to coordinating Ministries.

Private Sector (PHPs, PNFPs, CSOs) • Contributing towards policies development, planning, monitoring and evaluation. • Resource mobilisation for health care from households, organisations both local and international. • Providing or participating in research, community and social mobilisation, advocacy, capacity building including human resources development, logistical support, technical assistance and other services at all levels. • Ensuring proper utilisation of resources and accountability

CHAPTER THREE


3.2 PROCESS DESCRIPTION3.2.1 PlanningIndicator Setting and ValidationAt the start of the budget planning calendar, MDAs are required to review the existing performance indicators for each output/outcome for use in the forthcoming financial year. MDAs then submit the validated indicators to the sector secretariats at the lead ministry for compilation and submission to the relevant desk officers at OPM for quality assurance. At OPM, the desk officers specifically check for relevancy; completeness; obsolete and missing indicators and mismatch of indicators as part of the quality control procedures. OPM then summons the National Monitoring and Evaluation Working Group (OPM, UBOS, NPA, and MoFPED) to review and submit the approved performance indicators to Budget Directorate of MoFPED for incorporation within the National budget and the budget reporting tool (Programme Budgeting System (PBS) formerly the Output budgeting tool (OBT)). The sector desk officers are required to upload the approved performance indicators by 15th November of the current financial year. The approval of the indicators is based on ensuring that the indicators are specific, measurable, achievable, reliable and timely, i.e. SMART beginning with the OPM desk officers and completed by the National Monitoring and Evaluation Working Group.

Target Setting MDAs are required to set the targets in line with the available resource envelope and capacity to implement the development objectives of the institution. The MDAs set the output/outcome indicator targets during the budget framework paper preparation process. The targets are further reviewed during the preparation of the ministerial policy statement by MDA in line with the appropriated resources. The set targets are forwarded to OPM for review and approval, and re-forwarded to MFPED for input into the OBT/PBS.

3.2.2 BudgetingEach Accounting Officer in consultation with the relevant stakeholders prepares a Budget Framework Paper for the vote, taking into consideration balanced development, gender and equity responsiveness and submits it to the Minister by 15th November of the financial year preceding the financial year to which the Budget Framework Paper relates. The Budget Framework Paper is supposed to be consistent with the National Development Plan and with the Charter for Fiscal Responsibility. The Minister, with the approval of Cabinet, submits the Budget Framework Paper to Parliament by the 31st of December of the financial year proceeding the financial year to which the Budget Framework Paper relates. After consideration of the BFPs by parliament, entities also present to parliament their proposed budgets (ministerial policy statements) which are then discussed by the relevant committees as part of the budget approval process. Approval of the budget is evidenced through the enactment of the Appropriation Act by Parliament.

3.2.3 Budget Implementation Release of FundsAfter approval of the Budget Estimates by Parliament in May, the Ministry of Finance, Planning and Economic Development, issues a Budget Execution Calendar in June. The execution calendar communicates the Annual Quarterly Cash flow plan and the Operational and Administrative guidelines for budget implementation. The release of funds to Votes is undertaken in accordance with the cash flow plans and through a warranting process managed by the Accountant General and the Directorate of Budget. The MDAs are however advised to hold regular internal meetings to review the status of implementation of approved work plan from time to time. The meetings include Departmental meetings, Directorate meetings, Senior Management Meeting and Top Management Meetings.


Utilization of FundsAfter approval of the annual budget by Parliament, the Secretary to Treasury issues the annual cash flow plan of Government, based on the procurement plans, work plans and recruitment plans approved by Parliament. The annual cash flow plan issued forms the basis for release of funds by the Accountant General to the Accounting Officers. The Accounting Officer, based on the annual cash flow plan issued by the Secretary to the Treasury, plans and manages the activities as indicated in the policy statement of the vote. An accounting officer is charged with the overall responsibility for the successful execution of the procurement, disposal and contract management processes in the procuring and disposing entity.

Parliament may, by resolution, authorise the Minister to reallocate funds from a vote to another vote where the functions of a vote are transferred to that other vote. A vote that does not expend money that was appropriated to the vote for the financial year at the close of the financial year is expected to repay the money to the Consolidated Fund.

3.2.4 Monitoring and EvaluationTo ensure effective monitoring of the national health strategy, the MoH developed the M&E plan for the HSDP with clear indicators and targets for assessing performance and ensure availability of accurate and timely information on health sector performance. All programs and projects are also expected to develop specific program/project M&E Plans which should include programme indicators to measure process, outputs and immediate outcomes. These should, however, be aligned with the goal, objectives and strategic interventions of the HSDP to demonstrate the effects of health system strengthening to health outcomes.

At the national level, Bi-annual internal reviews by Sector Working Groups are carried out and include collating input and output performance data for key results as defined in Sector Investment Plans and the sector reporting framework. The bi-annual review includes all relevant sector stakeholders. The review focuses on the timeliness and accuracy of the collated performance data, before its upwards reporting, and recommendations for any corrective measures in the coming half year are made.

The budget of collating performance data and conducting quarterly and bi-annual reviews is provided for under the sector monitoring budget. Annual reviews are conducted by all Sector Working Groups, jointly with other stakeholders (such as Development Partners) as appropriate.

In addition to public institutions and executing agencies, citizens, Civil Society Organizations (CSOs) and Development Partners (DPs) play a role in the monitoring and evaluation of Government’s performance. These institutions; Provide an external perspective on Government performance and results, assist Government through financial, technical and other forms of assistance to strengthen its performance.

3.2.5 Performance ReportingAll MDAs are required to prepare and submit quarterly performance reports to the Ministry of Finance, Planning and Economic Development by 30th of the first month of the preceding quarter. e.g. the Third Quarter Report for the FY 2017/18 is required by 30th of April 2018. At MFPED, the reports are reviewed by the Desk Officers, and the Budget Monitoring Unit and issues of concern are brought to the attention of the relevant Accounting Officers for action.

In addition to the submitting reports to MFPED, MDAs are required to submit six months (Semi-Annual Government Performance Report and 12 months reports (Annual Government Performance Report) to OPM. A Cabinet retreat is held to review Government performance at half-year and after the end of the year and the retreat is coordinated by Office of the Prime Minister.

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CHAPTER FOUR

FINDINGS, CONCLUSIONS AND RECOMMENDATIONS

This chapter presents the audit findings, conclusions drawn from the findings and recommendation made for the improvement in implementation of the planned outputs by selected health sector institutions.

4.1 EXTENT OF DELIVERY OF PLANNED OUTPUTSThe eight (8) selected health sector institutions in the sector planned to implement and achieve a number of both recurrent and capital development outputs under various Programs and projects with set targets during the financial year 2017/2018. Based on the work performed during the audit, it was established that the selected entities in the sector partially achieved their planned outputs for the year.

Out of the fifty two (52) selected sample of planned outputs in the selected health sector institutions, fourteen (14) outputs were fully achieved representing 27% of the planned outputs, eighteen (18) were partially achieved (34.6%) and eleven (11) outputs representing 21.2% of the planned outputs were not implemented at all.

It was also observed that for the 9 outputs representing 17.3% of the planned outputs, the extent of delivery could not be assessed because no performance targets and indicators were set to facilitate the assessment. Set out in the Table 2 below is an analysis of performance of the selected entities.

Table 2: Showing extent of delivery of sampled planned outputs by selected entities

Entity No. of planned outputs

Actual outputs

Fully achieved Partially achieved Not Implemented No set targets (Not assessed)

MoH 27 7 9 9 2

Mulago NRH 1 1

UBTS 6 1 3 2

Gulu RRH 3 1 2

Fort Portal RRH 3 1 2

Masaka RRH 3 2 1

Mbale RRH 5 2 1 2

Mbarara RRH 4 2 2

Total 52 14 18 11 9

Source: OAG review of approved work plans, MPS, Budget estimates and 4th quarter performance reports 2017/18

As shown in the table above, MoH which is the largest player in the sector was able to fully achieve only 26% of its planned outputs. Similarly, for the rest of the entities the level of achievement ranged from 16.6% to 50%.It was observed that for the enteighteen (18) outputs that were patially achieved under various entities , the major contributing factors were procurement delays, budget short falls, delayed release of funds,diversion of funds among others as explained in Table 3 below;


Table 3: Showing reasons for partially achieved outputs by selected health sector institutions

Project Output Funding (UGX ‘000)

Causes for the variances

Ministry of Health

Project: 1185 Italian support to HSSP and PRDP

080282: 68 Construction of staff houses in Karamoja region

(Target :100% completion of civil works)

Budgeted: 5,619,000

Released: 5,619,000

Spent : 5,619,000

Achievement: 61.1% completed

Donor delayed to disburse funds and the contractor stopped working since December 2017

080201: Monitoring, Supervision and Evaluation

(Target 12 monthly monitor-ing visits)

Budgeted: 100,000

Released: 100,000

Spent : 100,000

Achievement: 4 monitoring visits done

The number of visits reduced because the cost of each field visit increased including involvement of Local lead-ers.

Project: 1243 Rehabilitation and construction of General hospitals

080280: Rehabilitation and equipping of Kawolo and Busolwe hos-pitals

(Target: 50% completion of civil works)

Budgeted: 19,282,000

Released: 4,020,000

Spent : 3,726,879

Achievement: 28.5% completed

Works on Busolwe have not yet commenced. No contract for works signed because the available funds are not enough to cover the scope of works needed. Some funds were re-allocated (UGX 30M)

Project: 1344 Renovation and Equipping of Kayun-ga and Yumbe Gen-eral Hospitals

080280: 30% civil works for rehabilitation and expansion of Kayunga and Yumbe Hos-pitals completed


Released: 19,322,667

Spent : 21,665,067

Achievement: 11%

Procurement delays.

Excess funds spent over the release (2,342,399,000) were funds diverted from other projects.

Project: 1394 region-al hospital for paedi-atric surgery

080280: completion of 50% of civil works

Budgeted: 9,428,039

Released: 9,428,039

Spent : 7,227,112

Achievement: 40% completed.

-Delays in clearance of imported ma-terials.

-Delays in release of counterpart funding, and continuous request for minor changes in the designs by the donors.

Diversion of funds (2,200,887,000)

080201: Monitoring, Supervision and evaluation (Hospital construction supervised)

Budgeted: 170,000

Released: 170,000

Spent : 169,987

Achievement: monthly monitoring done for 5 months

The project manager was not ap-pointed until the last quarter of the financial year.

Some funds were re-allocated




Project: 0220 global Fund for Aids, TB and Malaria

080575: Procure 7 delivery trucks for NMS and JMS 4 film Vans, Station Wagon, 2 cars for M&E officers

Budgeted: 3,415,896

Released: 3,415,896

Spent : 3,415,896

Achievement:

delivery trucks procured

2 film vans procured

1 station wagon procured

2 M& E cars procured for officers.

The two film vans were not yet procured due to Procurement delays

080577: Procurement of 150 Autoclaves, 239 GeneXpert Machines, Microscopes, Forklift, medicines shelves and racks, medicines boxes, x-ray machines



Spent : 31,857,132

Achievement:

150 autoclaves procured

Forklift procured

Medicines shelves and racks constructed

The x-rays, GeneXpert machines and microscopes are being procured through pooled procurement mechanisms of the Global Fund which have longer lead times. The procurement is on course and delivery is scheduled for March 2019.

1436: Gavi vaccines and Health sector Development plan support

080501:

Preventive and curative Medi-cal supplies

(Procure

1,437,600 HPV doses

3,362,000 PCV doses

1,591,500 Penta doses

2,917,500 Rota doses

No targets set for IPV doses)

Budgeted: 20,000

Released: 10,000

Spent : 10,000

Achievement:

881,580 of HPV doses

1,914,600 of PCV doses

1,911,000 of Penta doses

Inadequate funding since counter-part funds allocated annually (UGX 10 bn) for the vaccines have remained constant for about 15 years yet the number of children to be immunized is increasing.

MULAGO HOSPITAL COMPLEX

OPD and other ward con-struction and rehabilitation



Spent : 22,170,000

Achievement:

Construction of an organ transplant unit and remodeling of wards in final stages,

Funds worth UGX 14,203,379,232 were diverted




UBTS

Safe Blood Provision Collection of blood

240,000 unit of blood collected

300,000 blood donors recruited

240,000 unit of blood collected tested

Budgeted: 7,040,000

Released: 7,040,000

Spent : 7,040,000

Achievement:

209,633 units of blood collected

Unit collections were low due to inadequate test Kits and blood bags in Q1 and Q2

085301 Administrative support service

(target: -Management of facilities

-Replacement of old vehicles

-Maintenance of laboratory equipment

-Recruitment)

Budgeted: 1,000,000

Released: 1,000,000

Spent : 1,000,000

Achievement:

-Management of facilities

- one old vehicle replaced

Management explained that the funds allocated weren’t sufficient to implement all the planned activities.

Sub Programme 01: Administrative Support services

(Target: Construction of regional blood banks. (completion of Concepts, proposals and feasibility studies)

Maintenance of existing fa-cilities.

-Supervision and clinical in-terface to hospital clinicians and administrators)

Budgeted: 4,001,168

Released: 3,993,168

Spent : 3,663,834

Achievement:

-Supervision and clinical interface to hospital clinicians and administrators.

-Maintenance of existing facilities. -Recruitment of staff.

Other activities were not implemented due to insufficient budget allocations

GULU RRH

1004: Gulu Reha-bilitation Referral Hospital

Construction of 54 Unit staff houses

(Target Completion of the second slab and Initiation of the 3rd slab)

Budgeted: 1,338,000

Released: 1,338,000

Spent : 1,191,500

Achievement:

The second slab was not completed, and the 3rd slab hadn’t been initiated. (Overall achievement approx. 55%)

The slow progress of works was due to the limited annual funds allocated to the project by ministry of finance.

Part of these funds were diverted (UGX 146,500,000)

Demolition of the old radiol-ogy building

(Target: Complete demolition of the old radiology building and removal of debris)

Budgeted: 50,000

Released: 50,000

Spent : 48,000

Achievement:

Demolition done but the debris was not removed

This was due to Poor contract management




MASAKA RRH

01: Masaka Referral Hospital Services

Diagnostic services

(553,900 laboratory tests carried out

13,915 ultra sound scans made

5,949 x-ray examinations made)

Budgeted: 116,000

Released: 116,000

Spent : 113,500

Achievement:

(304,805 Laboratory tests done. 13,953 Ultra sound examinations done and 3784 X-Ray examinations done. 5,374 Blood transfusions done)

Lab. tests declined because of lack of reagents.

X-rays targets were not met due to inadequate and inappropriate supplies of x-ray films by National Medical stores.

1004: Masaka Rehabilitation Referral Hospital

085681: Staff houses con-struction and rehabilitation

(Foundation for all the 40 units staff hostel Completed 1 block of the staff hostel completed)

Budgeted: 500,000

Released: 500,000

Spent : 474,860

Achievement: (Raft foundation completed with steel and concrete.

This was because funding for the project was not adequate and as a result, the contractor only worked depending on availability of funds.

MBALE RRH

1478: Institutional support to Mbale Regional referral hospital.

085683: Construction and installation of a new incinerator and Renovation of acute care unit

(Target:100% completion of incinerator and putting it to use.)

Budgeted: 500,000

Released: 500,000

Spent : 404,209

Achievement:

Installation of incinerator completed but it was not yet in use by FY end ( 2017/18)

This was because there was need to change the roof structure of the incinerator house from wood as was in the original design to metal.

Source: OAG review of the approved annual work plans, MPS budget estimates and 4th quarter performance reports 2017/18

Outputs Not Implemented

The eleven (11) ouputs were not implemented in two (2) out of the eight (8) selected health sector institutions. The major reasons for failure to implement the planned outputs were; setting of unrealis-tic targets, inadequate preparedness to implement some outputs especially under the externally funded projects, budget shortfalls and diversion of funds among others, as explained in table 4 below;

Table 4: Showing reasons for non-implementation of the planned outputs

Programme Output Funding (UGX ‘000’) Audit observation

Ministry of Health

Project: 1344 Renovation and Equipping of Kayunga and Yumbe General Hospitals

080277: medi-cal equipment for full equipping of Kayunga and Yumbe hospitals

Budgeted: 6,700,000Released: 0Spent : 0

The set target was unrealistic since the medi-cal equipment could only be procured after completion of renovation and expansion of the hospital. Therefore the donorCould not release funds for the equipment as planned.


Project: 1440 Uganda Repro-ductive Mater-nity and Child Health Services Improvement Project

080280: Procure-ment of motor vehicles for support supervision

Budgeted: 2,847,330Released: 2,847,330Spent : 2,847,330

Funds were diverted to procure medical equip-ment

080276: Procure-ment of birth, death mobile services for NIRA


The allocated Funds not enough to execute the scope of works. The procurement had to be re-tendered.The budgets were overly ambitious coupled with unrealistic targets.

080277: Procure-ment of critical reproductive equip-ment


Management hadn’t done the needs assess-ment on the intended beneficiary health care institutions.

080281: Maternity units’ construction in the selected lo-cal government’s health centres


A needs assessment hadn’t been done.There were no approved designs for the project

1436: Gavi vac-cines and Health sector Devel-opment plan support

080503: Monitoring and evaluation ca-pacity improvement

Budgeted: 425,217Released: 207,173Spent : 207,173

External funds were not realized to implement all the planned activities. Funds were utilized towards monitoring other projects

080572: Govern-ment buildings and administrative Infrastructure


Funds were not released by the donor

080575: Purchase of Motor Vehicles and other transport Equipment



080575: Machinery and Equipment



MBARARA RRH

0856: Regional Referral Hospi-tal Services

08580: Hospital construction /Reha-bilitation


Funds meant to facilitate implementation of the activities were diverted to construct a staff canteen and orthopaedic workshop at a contract sum of UGX 198,345,610 and UGX 26,390,000* respectively.

08585: Purchase of Medical Equipment


Funds were diverted for emergency repair and maintenance of a CT-scan and an X-Ray ma-chine at a contract sum of UGX 323,099,860.331 and UGX 24,143,140 respectively.

Source: OAG review of the approved annual work plans, MPS, Budget estimates and 4th quarter vote performance reports 2017/2018

Outputs without targets and performance indicators

As observed above, the assessment of delivery of expected outputs could not be undertaken for the nine (9) planned outputs falling under five (5) entities.This was due to lack of clear targets and peformance indicators for those outputs. Details of these outputs are shown in Table 5 below;


Table 5: Showing outputs without targets and performance indicators

Entity Project Output Approved budgetUGX (‘000’)

Amount releasedUGX (‘000’)

Amount SpentUGX (‘000’)

MINISTRY OF HEALTH

Project 1027: Institutional support to ministry of health

080280:Hospital construction/ rehabilitation

1,620,000 1,620,000 1,620,000

080201: Monitoring, Super-vision and Evaluation

122,000 122,000 121,800

UBTS Safe blood Provi-sion

Purchase of office and ICT equipment

100,000 100,000 100,00

Purchase of office and Resi-dential furniture and fittings

20,000 20,000 19,800

FORT PORTAL RRH

0856: Regional Referral Hospital Services

08572: Government Build-ings and Administrative Infrastructure

39,572,000 39,572,000 37,200,000

08581: Staff houses construction and rehabilitation

882,428,000 882,428,000 54,893,000

MASAKA RRH Output 085682: Maternity ward construction and rehabilitation

1,558,000 1,558,000 1,027,655

MBALE RRH 1004: Mbale Reha-bilitation Referral Hospital

085683: OPD and other ward construction and rehabilitation (Construc-tion of surgical and cancer ward)

2,000,000 2,000,000 1,999,666

85685: Medical Equipment 227,571 227,571 227,359

Discussed in the next section are the various factors that impact on the delivery of the expected outputs in the sector. The factors arise from the review of the key processes resulting to planning, budgeting, release and utilization of funds, monitoring and evaluation.

4.2 PLANNING AND BUDGETING

The NDPII stresses the importance of the alignment of planning and budgeting instruments to ensure ef-ficient and timely implementation of activities while keeping the focus on national priorities. Section 13 (6) PFMA, 2015 requires the annual budget to be consistent with, the National Development Plan, the Charter of Fiscal Responsibility and the Budget Framework Paper. This alignment also ensures accurate reporting of the outputs and outcomes planned in the NDPII, sector and MDA plans.

A review of the certificate of compliance of the annual budget 2017/18 assessment report by National Planning Authority (NPA) indicated that the Health sector is 51.7 percent compliant. Specifically, the sector performed at 88%, 38.1%, 67.6% and 37.3% at planning, project implementation, budget process instruments (BFP and AB) and annual budget performance, respectively. The performance was on account of low budget absorption by the majority of health sector institutions especially under projects. The perfor-mance of the selected individual public spending entities in the health sector is summarized in the Table 6 below;


Table 6: Summary of Selected Health Sector and MDA Compliance Assessment (%)

S/N MDA Planning Alignment (BFP & AB)

Budget Performance

Projects Performance

Total Score

1. Budget Performance 100 56.5 0.0 0 21.3

2. Uganda Blood Transfusion Service

100 70 40.0 40.0 52.0

3. Mulago Hospital Complex 0 83.0 60.0 65.1 54.1

4. Fort Portal Referral Hospital

0 70.0 40.0 95.1 54.5

5. Gulu Referral Hospital 100 36.9 40.0 95.1 61.9

6. Masaka Referral Hospital 100 69.8 40.0 77.5 69.2

7. Mbale Referral Hospital 100 56 40 40 55.2

8. Mbarara Referral Hospital

100 89.2 40.0 57.5 67.1

Source: OAG review of the certificate of compliance of the annual budget 2017/18 assessment report by National Planning Authority

As shown in the table above, the sector is doing well in terms of strategic planning as six (6) out of the eight (8) selected entities have approved strategic plans. Also available is the approved health sector development plan which is aligned to the NDPII. However Mulago Hospital Complex and Fort Portal RRH scored 0% at planning on account of not having approved strategic plans. In terms of budget performance, the sector was 37.3 percent compliant on account of its performance on budget outturn and expenditure outturn.

Furthermore, from the review of the NDPII and the MPS for the financial year 2017/18, the audit team established that programs and projects worth UGX 66,074,296,000 that were prioritized and planned to be implemented by Ministry of Health and whose funding accordingly released in the financial year 2017/18 from both development partners and government of Uganda were not among the health sector priority projects proposed under the NDPII.

MoH indicated that these projects came along after the approval and commencement of the NDPII and after the Ministry had negotiated and secured funding from development partners.

Although they indicated that the interventions/projects were in line with the sector objectives, the certificates of compliance were not availed to justify their prioritization.

Adoption of projects not aligned to the NDPII poses a risk of government not achieving the expected national development objectives and outcomes for the health sector as set out in the national development plan.

A further comparison of the Ministerial Policy Statement (MPS) 2017/18 and the approved budget estimates revealed that some outputs were allocated funds in the approved budget but the allocations in the MPS were not in tandem with the amounts reflected in the approved budget for the same year. Details are in Table 7 below;


Table 7: Showing inconsistencies between the MPS FY 17/18 and the approved budget estimates

Project Output MPS Amount (UGX) Approved budget estimates (UGX)

1027: Institutional support to MoH

080275: Purchase of motor vehicle and other transport equipment

0 20,000,000

080276: Purchase of office and ICT Equip-ment including software.

0 55,000,000

1243: Rehabilitation and Con-struction of General Hospi-tals

080280: Hospital construction/ rehabilitation

300,000,000 450,000,000

1315: Construction of special-ized neonatal and maternal Unit in Mulago Hospital

080280: Hospital construction/ rehabilitation

0 1,500,000,000

1436: Gavi vaccines and Health sector Development plan support

080572: Government buildings and ad-ministrative Infrastructure

0 6,18,906,000

080575: Purchase of Motor Vehicles and other transport Equipment

not Indicated 4,596,775,000

080577: Purchase of Specialized Machin-ery and Equipment

not Indicated 15,355,562,000

Source: OAG analysis of the MPS and approved budget estimates FY 17/18

Inconsistencies between the MPS and the approved estimates are partly caused by failure by MoH to properly document the adjustments agreed upon during the budget approval process. Such inconsistencies can pose a challenge in performance reporting.

Management explained that the adjustments are communicated to MoH through minutes by the secretary to the parliamentary committee on health, and these changes are updated on the system (PBS tool) and forwarded to the ministry of finance. Furthermore, according to the officials from the MoH planning department, the copies of the adjusted MPS are not printed because of cost implications.

Management ResponsesIt is now a requirement that all projects implemented by Government have to be approved by the Development Committee of Ministry of Finance Planning and Economic Development and a certificate of compliance has to be provided by Parliament as a pre-requisite for approval of loans. Therefore, the projects mentioned were aligned to the NDP II as required by Government.

Management wishes to note that the MPS is presented to Parliament in April while the budget is approved in June and it is during this period that most development partners confirm their allocations. This is the main reason for variations as well as re-allocations and recommendations made by Parliament. Our approved budget estimates are consistent with the annual work plan.

Audit CommentCertificate of compliant was not presented to justify prioritization of the interventions. RecommendationsManagement should;a) Strive to always give priority to the proposed NDPII health sector interventions and targets during planning and budgeting. The tendency to take on new projects outside NDPII projects should be restrained or undertaken in accordance with the national planning framework.


b) Ensure that the MPS is adjusted to reflect any changes approved by parliament as indicated in the approved budget estimates.

4.3 RELEASE/DISBURSEMENT PERFORMANCEAfter approval of the annual budget by Parliament, the Secretary to Treasury issues, the annual cash flow plan of Government, based on the procurement plans, work plans and recruitment plans approved by Parliament and this forms the basis for release of funds by the Accountant General to the Accounting Officers.During the FY 2017/2018, out of the total UGX. 1.95 trillion allocated to the Health Sector, UGX. 1.28 trillion which represents 66% was released. All votes received about 100% of the budget except MoH with only 36%.

For the selected sample of eight (8) entities, the review of the Ministerial policy Statements, approved Budget estimates and the Health Sector performance report showed that Parliament appropriated a total of UGX. 1,088,.092 bn for the eight (8) entities to cater for recurrent expenditure (UGX. 148.805 bn) and capital development (UGX. 939.287 bn). Out of the recurrent budget, UGX. 143.367 bn (96.3%) was released while for capital development budget the disbursements amounted to UGX. 338.881 bn (36.1%) representing a shortfall of UGX. 5.438 bn (3.7%) and UGX. 600.407 bn (63.9%) respectively. Details of release performance are shown in Table 8 below;

Table 8: Showing Release performance for Selected Health Sector Entities FY 2017/18

Entity Budget Component

Approved Budget (UGX billions)

Amount Released/ disbursed (UGX billions)

Variance (UGX billions)

% Variance

Ministry of Health

Recurrent 64.485 59.636 4.849 7.52%

Capital Development

907.255 306.863 600.393 66.2%

Mulago hospital complex

Recurrent 44.997 44.997 0 0%

Capital Development 22.02 22.02 0 0%

UBTS Recurrent 12.701 12.701 0 0%

Capital Development 0.37 0.356 0.014 3.8

Mbale RRH Recurrent 6.935 6.935 0 0%


Mbarara RRH Recurrent 4.79 4.79 0 0%


Gulu RRH Recurrent 5.46 5.46 0 0%


Masaka RRH Recurrent 4.159 4.159 0 0%


Fort Portal RRH Recurrent 5.278 5.278 0 0

Capital Develop-ment 1.06 1.06 0 0%

Total 1,088.092 482.837 605.256 55.6%Source: OAG review of the MPSFY 2017/18, IFMIS Budget analysis report and Annual Health Sector performance report 2017/2018.


The table above shows that overall 44.4% of the approved budget was realized by the entities. Most of the entities received their entire budgetary allocations except MoH which realized 37.7%. For MoH the shortfall was caused by low disbursement performance from external financing as only 33.8% of budgted funds were realised. Regarding counterpart funding, it was observed that government released 103% of its expected counterpart funding contributions on all the externally funded projects as shown in Table 9 below.

Table 9: Showing percentage release of external financing Vs GoU counterpart funding

Component Approved Budget (UGX billions)

Amount released (UGX billions)

Percentage of Budget released

External financing 878.415 269.532 30.7%

GoU counterpart funding 15.389 15.83 103%

Source: MPS FY 2017/18, IFMIS payment file, budget estimates, Project financial statements and MoH Cumulative Vote

performance report for the 4th quarter

Analysis by the audit team indicated that due to the poor release performance, a number of outputs and tar-gets were either not implemented or partially implemented. For example under MoH, the analysis showed that for a selected sample of five (5) capital development projects having an appropriation of UGX 131.08 bn and amount released of UGX 29.01 bn constituting (3.2%) of the capital development appropriation and (9.45%) of the amount released respectively, over 77% of the amounts allocated funds were not released/ disbursed for implementation of activities. Consequently, seven (7) of the nine planned (9) outputs did not receive funds and were not implemented as indicated in Table 10 below;

Table 10: Showing Unreleased funds on sampled outputs under MoH

Program/ Project Output Budgeted Amount

(UGX ‘000’)

Amount released (UGX

‘000’)

Variance (UGX ‘000’)

% variance

Reasons for Variance

1436: Gavi vac-cines and Health sector Develop-ment plan sup-port

080572: Govern-ment buildings and administra-tive Infrastruc-ture

6,188,906 0 6,188,906 100 The donor did not release funds. Due to some pending verifica-tions of the first phase of the Health Systems Support 1(Appendix V)

080575: Pur-chase of Motor Vehicles and other transport Equipment

4,596,775 0 4,596,775 100 The donor did not release funds. due to some pending verifica-tions of the first phase of the Health Systems Support 1(Appendix V)


Program/ Project Output Budgeted Amount

(UGX ‘000’)

Amount released (UGX

‘000’)

Variance (UGX ‘000’)

% variance

Reasons for Variance

Project: 1440 Uganda Repro-ductive Mater-nity and Child Health Services Improvement Project

080276: Procure-ment of birth, death registra-tion mobile ser-vices procured for NIRA

2,695,472 0 2,695,472 100 The procurement was re-tendered because the allocation made was not enough to cover the scope of works (Appen-dix V)

Full procurement of critical medi-cal equipment

4,000,000 0 4,000,000 100 The needs assessment of the health centres countrywide for medical equipment hadn’t been done (Appendix V)

Construction of maternity units in selected health centres

11,522,195

0

11,522,195 100 Management hadn’t developed technical designs for the con-structions.(Appendix V)


080277: medical equipment for full equipping of Kayunga and Yumbe hospitals

6,700,000 0 6,700,000 100 Procurement of Equip-ment had to await com-pletion of works on the hospitals. (Appendix V)

080280: 30% of civil works for rehabilitation and expansion of Kayunga and Yumbe Hospitals completed

27,885,000 19,322,667 8,562,333 30.7 The project started late due to procure-ment delays and so the anticipated completion of works couldn’t be achieved. (Appendix V)

Project: 0220 global Fund for Aids, TB and Malaria

080572: Con-struction of med-icines warehouse in Kajjansi

48,214,788 0 48,214,788 100 The project was implemented by NMS. (Appendix IV)

Project: 1243 Rehabilitation and construc-tion of General hospitals

080280: rehabili-tation of equip-ping of Kawolo and Busolwe hospitals

19,282,000 9,688,432 9,593,568 49.8 Works at Busolwe did not start as anticipated because of funding challenges (Appendix V)

Total 131,085,136 29,011,099 102,074,037 77.9% Source: OAG review of the MPS FY 17/18, and the IFMIS Budget analysis reports

It was observed that for the majority of outputs, MoH made unrealistic plans and targets for the outputs and lacked the necessary preparedness to execute them.

This not only distorts the overall planning and budgeting of government but also delays the implementation and accrual of benefits to the intended beneficiaries.

RecommendationManagement should ensure that all the necessary preparations in terms of feasibility, baseline studies, needs assessments and execution plans are done and strictly followed as laid out in the Project documents to enable timely disbursement of funds from donors.


4.4 UTILIZATION / ABSORPTION OF FUNDSAccording to PFMA 2015, Sec. 21(1) an Accounting Officer shall, based on the annual cash flow plan issued by the Secretary to the Treasury under section 15, plan and manage the activities as indicated in the policy statement of the vote. Out of the total release of UGX 1.28 trillion, the health sector spent a total of UGX 1.191 trillion representing 93.04% of the released amount. For the 8 selected entities the analysis showed that the entities spent 79% of the amount released as shown in Table 11 below.

Table 11: Showing Health Sector approved budget absorption rates FY 2017/18

Entity Budget Component

Approved Budget

(UGX billions)

Amount Released

(UGX billions)

Amount Spent (UGX billions)

Balance Unspent

(UGX billions)

% of unspent balances

Ministry of Health

Recurrent 64.485 59.636 56.197 3.439 5.77

Capital Development 907.255 306.863 217.129 89.73429.24

Mulago hospital complex

Recurrent 44.997 44.997 41.587 3.41 7.58

Capital Development 22.02 22.02 22.02 0 0.00

UBTS Recurrent 12.701 12.701 12.37 0.331 2.61

Capital Development 0.37 0.356 0.353 0.003 0.84

Mbale RRH Recurrent 6.935 6.935 6.685 0.25 3.60


Mbarara RRH

Recurrent 4.79 4.79 4.363 0.427 8.91


Gulu RRH Recurrent 5.46 5.46 4.653 0.807 14.78


Masaka RRH

Recurrent 4.159 4.159 4.007 0.152 3.65

Capital Development 2.058 2.058 2.058 0 0.00

Fort Portal RRH

Recurrent 5.278 5.278 4.434 0.844 15.99


Total 1,088.092 482.837 383.408 99.429 20.59

Source: OAG review of the approved budget estimates, MPS, IFMIS payment files and vote performance reports 2017/2018

The eight (8) selected entities did not absorb a total of UGX 99.429 bn representing 20.59% of the released funds. The unutilized funds were mainly funds earmarked for construction projects, procurement of special-ized medical equipment, pension, gratuity and social contribution, among others. Six (6) entities absorbed approximately 99% of their capital development budgets whereas MoH was unable to absorb 29.2% of its capital development release.

Failure to absorb funds was attributed to Procurement delays, and delayed verification of decentralised pensioners in Regional Referral Hospitals. Management ResponseLong procurement processes and delays in obtaining necessary approvals from development partners including release of funds remain critical challenges to the absorption of externally financed projects.


RecommendationManagement should:a) Initiate the procurement processes early enough and seek the necessary approvals from the key stakeholders to ensure that the released funds are absorbed as planned.b) Expedite the verification process of all pensioners to ensure timely payments of pension and gratuity.

Further analysis of the performance of the selected outputs revealed that in addition to poor release performance, the delivery of the expected outputs was affected by budget variations such as reallocations, diversion/ mischarge of funds and delays in procurement as further discussed in the paragraphs below;

4.4.1 Re-allocation of Funds on selected outputsOut of the eight (8) selected health sector entities, reallocations of funds were observed only in MoH. From the review of the ministry’s six (6) selected outputs falling under 5 projects, the audit team established that a total of UGX 483,583,000 representing 9.8% of the output budget allocation was reallocated from the selected outputs towards other activities as shown in Table 12 below:

Table 12: Showing Funds Re-Allocation for a selection of outputs

Programme/project Output Budget allocation

(UGX ‘000’)

Re-allocation (UGX ‘000’)

% Output/ Programme reallocations

1027: Institutional support to MoH

080272: Ministry of health Headquar-ters renovated following the fire and office accommodation modernized

1,542,000 (154,000) 10%

080280: Hospital construction/ reha-bilitation

1,800,000 (180,000) 10%

Project: 1187 Support to Mu-lago Hospital Rehabilitation

080280: Hospital construction/ reha-bilitation

950,000 (95,000) 10%

Project: 1243 Rehabilitation and construction of General hospitals

080280: Rehabilitation of equipping of Kawolo and Busolwe hospitals(GoU Development)

300,000 (30,000) 10%


080201: Monitoring, Supervision and Evaluation

300,820 (18,490) 6%

Project: 0220 Global Fund for AIDS, TB and Malaria

080503: Monitoring, Supervision and Evaluation (GoU contribution- mainte-nance of vehicles)

60,930 (6,093) 10%

Total 4,953,750 (483,583) 9.8%

Source: OAG analysis of the approved budget estimates, payment file, and IFMIS Budget analysis report FY 2017/18

In spite of the reallocations, MoH did not adjust the corresponding planned output targets to reflect the corresponding changes in the budgetary allocations. For example, the target of 50% completion of works for FY 2017/18 Busolwe general hospital was not adjusted among others.

Management ResponseManagement wishes to note that changes arising out of re-allocations are automatically reflected in the IFMS.


RecommendationManagement should always re-adjust work plans and re-set planned output targets after funds re-alloca-tions on the various outputs as this will facilitate accurate reporting on the achievement of planned outputs.

4.4.2 Diversion of FundsSection 10.4 of the treasury instructions 2017 states that, in reviewing payment requests, an Accounting Officer shall have a primary responsibility of ensuring that there is no mischarge and diversion of funds through wrong coding of transactions and an Accounting Officer shall be held personally liable for any wrong charge accounts used for expenditure incurred by his or her vote.

A review of the Annual approved estimates, Work plans and the payment file for the sampled outputs revealed that a total of UGX 28.73 billion was diverted from the planned outputs towards other activities without authority as shown in Table 13 below;

Table 13: Showing funds diverted from the planned sampled outputs

Entity Amount Released

(UGX)

Amount Diverted

(UGX)

% of diversions

Ministry of Health 22,528,959,000 13,060,409,000 58

Mulago hospital complex 22,020,000,000 14,203,379,232 64.5

UBTS 87,942,000 80,092,259 91.1

Fort Portal RRH 1,020,428,000 59,200,000 5.8

Gulu RRH 1,338,000,000 146,500,000 10.9

Masaka RRH 2,058,000,000 278,577,914 13.5

Mbale RRH 580,709,000 119,719,823 17.1

Mbarara RRH 1,050,000,000 522,818,030 49.8

Total 50,684,038,000 28,470,287,258 56.2

Source: OAG analysis of the payment files and IFMIS Budget analysis reports 2017/2018

The analysis showed that on average over 50% of the funds released for the above Sub-Programs were not spent on the planned outputs (details in Appendix V).This impacted on the achievement of the planned outputs. For example Motor vehicles for support supervisions and districts, under the Uganda Reproductive Maternal and Child Health services Improvement Project, construction of the Regional hospital for pediatrics surgery all under MoH, Monitoring, supervision & Appraisal of capital works at Fort Portal RRH, Renovation of maternity and Surgical wards to improve on the labour suite and all other service areas on the two wards, and Purchase of assorted medical equipment including monitors for high dependency units (Sterilizers and laundry machines) in Mbarara RRH among others were affected by the diversions above.

RecommendationManagement is advised to desist from diverting funds towards unplanned activities. Where budget variations are inevitable, approvals for reallocations should be sought and planned targets adjusted accordingly. 4.4.3 Timeliness of the procurement processIn order to achieve timely delivery of services, procurement processes must be undertaken in a manner that ensures that the best service providers are identified in time.

For this analysis the team assumed that an efficient health sector entity would require at most sixty (60) days to complete the procurement of a service provider /contractors (from approval of bid documents to contract signing) as broken down in table 14 below;


Table 14: Detailing the time required for different activities of the procurement process

No Procurement activity Maximum no of days required

1 Approval of bid documents 5

2 Advertising for cases of open bidding 15

3 Evaluation of bids 5

4 Approval of evaluation reports 2

5 Notice of best-evaluated bidders 10

6 Approval/ clearance from Solicitor General 14

7 Contract signing 3

8 Any other activities that may be necessary 6

Total required days 60

The audit team analysed time taken between the date of approval of bid and the date of contract signing by the health sector entities.It was established that three (3) out of eight (8) selected health sector entities that is; MoH, Mbarara RRH and Mbale RRH lost significant amount of time between the date of approval of bid document and contract signing. From the analysis of the time between the date of bid approval and the date of contract signing, audit observed that the procurement process took more than 60 working days before contracts with contractors and service providers were signed. The delays ranged from 10 to 417 days as indicated in Appendix VII.

The procurement delays in the externally funded projects were attributed to long approval requirements by donors at various stages. For GoU capital development projects the procurement delays were attributed to changes in designs and administrative reviews that resulted into re-evaluation.Delays in the execution of the procurement processes translate into delays in project implementation which affects the timely realisation of the Programme outputs.

Management Response Advice is noted. Steps are being taken to improve procurement efficiency. Two specialists for MoH have been recruited to help improve capacity of the Procurement and Disposal Unit. This notwithstanding, delays still occur because of the lengthy consultative process requiring development partners to approve each stage of the procurement process.

RecommendationManagement should endeavour to expedite the procurement processes early enough most especially where approvals are required from stakeholders to facilitate timely implementation of planned activities.

4.5 MONITORING AND EVALUATION To ensure effective monitoring of the national health strategy, the MoH which is the lead sector agency de-veloped the M&E plan for the HSDP with clear indicators and targets for assessing performance and ensure availability of accurate and timely information on health sector performance. All programs and projects are also expected to develop specific program/project M&E Plans which should include Programme indicators to measure process, outputs and immediate outcomes. These should be aligned with the goal, objectives and strategic interventions of the HSDP to demonstrate the effects of health system strengthening to health outcomes12.

12 MoH Strategic Plan 2015/2016-2019/2020


In addition, the MoH M&E Framework for implementation of the HSDP points out that annual program/ project reports are a requirement from all programs and projects based on their specific M&E plans. Progress review reports shall be submitted to the MoH M&E unit before the annual sector reviews.

From the Interviews held with project coordinators, heads of departments and accounting officers in the selected entities, the audit team established that there were no specific monitoring and evaluation work plans with clear set targets and indicators to facilitate monitoring of planned activities for the programs and projects selected for review. It was further noted through review of the expenditure files that although funds amounting to UGX 1,287,353,819 were spent on monitoring and evaluation of projects and programs, there were no specific monitoring and evaluation reports on file to confirm that the expected M&E activities were carried out and recommendations made for corrective action.

This was partly caused by lack of fully-fledged M&E units/committees to plan and monitor all the programs and projects as per the designed M&E frameworks/ strategic plans. There was no specific sector M&E team to consolidate all the reports generated from other health sector agencies and local governments to enable enforcing of recommended corrective actions. As a result, performance gaps could not be identified timely to facilitate r corrective action. In addition, data validation could not be done which led to inconsistencies in reporting on the sector performance.

Accounting officers explained that whereas there is no fully fledged M&E units/ committees the Programs and projects implemented under each entity have project managers appointed and responsible for ensuring proper implementation of the Programmes/projects. For MoH, the infrastructural projects always appoint supervising consultants to conduct monthly reviews and assessment of the progress of works and report to the Ministry accordingly. Further, various Government organs and units such as Budget Monitoring and Accountability Unit (BMAU) and Office of the Prime Minister (OPM) monitoring units provide adequate monitoring of programs and projects implemented under the selected entities.

Management Response Traditionally the MoH has been employing M&E Personnel but deployed under different programs for example GAVI, Global Fund and World Bank projects. As auditors observed, there is need to coordinate the M&E officers in the Ministry. The Ministry has requested the Ministry of Public Service to allow for establishment of an M&E unit in the Ministry of Health. Approval is now awaited.

Audit CommentThe monitoring of activities in the selected institutions are not properly coordinated since there are no reports produced with recommendations for corrective action to be enforced by management or designated M&E committees.

RecommendationAll health sector entities are advised to constitute M&E units to properly coordinate the monitorng and implementation of activities, consolidate all the reports generated from the individual Programme/project monitoring teams/committees and follow up recommended corrective actions. In addition, the established units should ensure that specific M&E plans are developed with clear indicators and targets for assessing performance and ensure availability of accurate and timely information on health sector performance.


Performance Reporting According to the budget execution circular 2017/18 Accounting Officers are required to submit quarterly budget performance reports indicating the actual performance against the planned outputs and perfor-mance for each quarter showing the quality/quantity and physical location of the reported outputs against expenditure using the format in the PBS.13

Review of the annual work plans, approved budget estimates and the 4th quarter cumulative performance reports indicated that in all the selected health sector institutions, there were errors and inconsistencies in reporting on the delivery of outputs and in some instances there was no relationship between the planned outputs and the actual reported achievements. Also the revised approved budget figures in the Ministerial policy statements and cumulative vote performance reports were at variance with the Actual revised budg-eted figures captured in the IFMS. Details are indicated in Appendix VIII.

Accounting officers explained that FY 2017/2018 was the first year of implementation of the PBB system hence the user challenges. However, they indicated that in case of any revisions to the work plans or mis-charge/ diversions, the system does not put those into consideration during report generation hence the inconsistencies.

Inaccurate reporting by the sector distorts the government annual performance information and may result in inappropriate policy decisions.

RecommendationsManagement should ensure that the performance is accurately reported to inform appropriate government policy actions.

OVERALL CONCLUSION Overall the selected eight (8) entities in the sector partially achieved their expected planned outputs for the year. The delivery of the expected outputs and targets was affected by weaknesses in planning, budget shortfalls, and challenges in absorption, procurement delays and budget variations among others. To im-prove on the output delivery, it is important that the existing weaknesses in monitoring and evaluation are also addressed to ensure corrective action and accurate information for decision making.

13 MoH Strategic Plan 2015/2016-2019/2020


GLOSSARY OF KEY TERMS

Absorption Funds spent by MDA’s as a proportion of the funds released from Central Government approved Budget. This is the appropriated budget by the Parliament of the Republic of Uganda, which is normally undertaken in May of the proceeding, Financial Year.

Expenditure Actual spending by MDA’s (recorded by EFT transfers) reported on the IFMS and Legacy systems.

Item This is the lowest operational level of the budget, and represents the resources necessary to carry out activities, e.g. staff salaries, and travel inland, printing and stationery.

Key Performance Indicators These measure the performance of Programme Key Outputs, e.g. No. of health centres constructed.

Percentage of Budget Released This is the percentage of the approved budget (excluding supplementary budgets appropriated in year) that is released by Central Government.

Percentage of Budget Spent This is the percentage of the approved budget (excluding supplementary budgets appropriated in year) that is spent by MDAs through EFT transfers.

Sub-Programmes (Departments) These represent the results or sets of activities implemented by the Vote which contribute to the achievement of the Programme objectives. These are recurrent in nature, e.g. inspection of primary schools.

Sub-Programmes (Projects) These represent the results or set of activities implemented by the Vote which contribute to the achievement of Programme objectives. They primarily involve capital purchases and may be financed by the Government of Uganda and/or Development Partners, e.g. Emergency construction of specialized hospitals.

Release Central Government transfer of funds to MDA’s (including supplementary funds) from the consolidated fund.

Sector These are groups of institutions (Votes) or parts of institutions which contribute towards a common function, e.g. Health.

Supplementary Budget This is an in year addition to an MDAs’ approved budget. This budget is also appropriated by Parliament during the course of the Financial Year.

Unspent balances Funds that were released by Central Government but not spent by MDA’s. This calcula-tion does not include commitments (encumbrance) on the IFMS system.

Programmes These are groups of related services and capital investments delivered by a Vote or deliv-ered on behalf of that Vote by another institution e.g. Regional Referral services.

Votes These are institutions (Ministries, Departments, Agencies and Local Governments) which are the basis of the annual budget and appropriations made by Parliament, and the basis for accountability, e.g. Ministry of Health.


OFFICE OF THE MINISTER

PERMANENT SECRETARY

NDA

Mulago National RH

Butabika National Mental RH UBTS

RRHs

UNHRO

UVRI UNCRI

UCI UHI

NMS

DIRECTOR GENERAL HEALTH SERVICE

DIRECTOR OF CLINICAL AND COMMUNITY

DEPARTMENT OF NURSING

DEPARTMENT OF NATIONAL DISEASE

DEPARMENT OF COMMUNITY

HEALTH

DEPARTMENT OF CLINICAL SERVICES

DIRECTOR OF PLANNING AND DEVELOPMENT

DEPARTMENT OF PLANNING

DEPARTMENT OF QUALITY

ASSURANCE

- PC - UMDPC - UNMC - AHPC

UGANDA AIDS COMMISSION

HEALTH SERVICE COMMISSION

DEPARTMENT OF FINANCE AND ADMINISTRATION

APPENDICES

Appendix I: Macro structure of the Health Sector


Appendix II: Selected entities, programmes and sub programmes

SELECTED PROGRAMMES AND OUTPUTS APPROVED BUDGET (2017/18)

MINISTRY OF HEALTH 971,730,000,000

PROGRAM

Health infrastructure and equipment 97,747,000,000

SUBPROGRAM

District Infrastructure Support Programme

OUTPUTS:

Health center construction and rehabilitation 1,300,000,000

Staff houses construction and rehabilitation 500,000,000

SUBPROGRAM

Institutional support to MOH

OUTPUTS:

Government buildings and Administrative infrastructure 1,542,000,000

SUBPROGRAM

Italian support to HSSP and PRDP

OUTPUTS:

Staff houses construction and rehabilitation 5,619,000,000

SUBPROGRAM

Support to Mulago Hospital Rehabilitation

OUTPUTS:

Hospital construction/rehabilitation 950,000,000

SUBPROGRAM

Rehabilitation and construction of General Hospitals

OUTPUTS:

Hospital construction/rehabilitation 18,982,000,000

SUBPROGRAM

Renovation and Equipping of Kayunga and Yumbe General Hospitals

OUTPUTS:

Hospital construction/rehabilitation 27,885,000,000

Purchase of specialized Machinery and Equipment 6,700,000,000

SUBPROGRAM

Regional Hospital for Pediatric Surgery

OUTPUTS:

Hospital construction/rehabilitation 800,000,000

Purchase of Motor Vehicles and Other Transport Equipment 2,847,330,000

Purchase of office and ICT Equipment, including software 2,695,472,000

Purchase of Specialised Machinery and Equipment 7,319,536,000

Health center construction and rehabilitation 11,522,195,000

PROGRAM

Pharmaceutical and other Supplies


SUBPROGRAM

Global Fund for Aids, Tb and Malaria

OUTPUTS:

Government building and Administrative infrastructure 48,214,788,000

Purchase of motor vehicles and other transport equipment 3,415,496,000

Purchase of specialised machinery and equipment 31,857,132,000

SUBPROGRAM

GAVI Vaccines and Health centre development plan support

OUTPUTS:

Government building and Administrative infrastructure 92,431,000,000

MULAGO NATIONAL REFERRAL HOSPITAL 67,020,000,000

PROGRAM

National Referral Hospital Services

OUTPUTS:

Demolition and Rebuilding of OPD and ICU 22,170,000,000

OUTPUT

OPD and other ward construction and Rehabilitation 22,520,000,000

UGANDA BLOOD TRANSFUSSION SERVICES 13,060,000,000

PROGRAM

Safe Blood Provision

OUTPUTS:

Collection of blood 3,800,000,000

Purchase of motor Vehicle and other transport Equipment 250,000,000

Purchase of office and ICT equipment 100,000,000

Purchase of office and Residential furniture and fittings 20,000,000

: 085301 Administrative support services

-Management of facilities

-Replacement of old vehicles

-Maintenance of laboratory equipment

-Recruitment

1,000,000,000

: Administrative Support services

Construction of regional blood banks.

Maintenance of existing facilities.

-Supervision and clinical interface to hospital clinicians and administrators.

-Recruitment of staff.

4,001,168,000

MBALE REGIONAL REFERRAL HOSPITAL 10,000,000,000

PROGRAM

Regional Referral Hospital Services

SUBPROGRAM

Mbale Rehabilitation Referral Hospital

OUTPUTS:


OPD and other ward construction and rehabilitation (Construction of surgical and cancer ward) 2,000,000,000

Other structures ( Construction and installation of a new incinerator and Renovation of acute care unit

500,000,000

Machinery and Equipment ( Purchase of hospital vehicle 200,000,000

Office Equipment 130,000,000

Medical Equipment 227,571,000

SUBPROGRAM

Institutional support to Mbale Regional Hospital

OUTPUT:

OPD and other ward construction and rehabilitation 830,429,000

MBARARA REGIONAL REFERRAL HOSPITAL 6,770,000,000

PROGRAM


SUBPROGRAM

Mbarara rehabilitation Referral Hospital

OUTPUT:

Purchase of a transport equipment- To buy a 30 seater van for transporting staff members during different official functions

400,000,000

Renovation of Maternity ward and surgical ward to improve on the labor suit and all other ser-vice areas on the two wards

350,000,000

Purchase of assorted medical equipment including monitors for high dependence units 300,000,000

16 unit staff quarters completion 928,000,000

GULU REGIONAL REFERRAL HOSPITAL 6,950,000,000

PROGRAM


SUBPROGRAM

Gulu Rehabilitation Referral Hospital

OUTPUT:

Construction of 54 Unit staff houses 1,338,000,000

Demolition of the old radiology building 50,000,000

Procurement of assorted medical equipment 100,000,000

FORT PORTAL REGIONAL REFERRAL HOSPITAL 6,345,000,000

ROGRAM


SUBPROGRAM

Fort portal rehabilitation Referral Hospital

OUTPUTS:

Staff houses construction and rehabilitation 882,428,000

Purchase of Medical Equipment 138,000,000

Government Buildings and Administrative Infrastructure 39,572,000


Appendix III: Documents Reviewed

Document Reviewed Implementing Agency Purpose

Second National Devel-opment Plan 2015/16-2019/20 (NDPII)

Ministry of Health & affiliated autonomous institutions

• To ascertain the key priority objectives sector objectives that are to be pursued by the implementing agencies under the health sector

Second National Health policy 2010


• To ascertain those policies adopted by the health sector and their alignment with the NDPII.

• To establish how those key priority objectives that the health sector is to pursue.

• To understand the legal background/ frame work and mandate of the Health sector.

Health Sector Strategic and Investment Plan (HSSIP) 2010/11-2014/15


• To ascertain the long and medium-term agenda of the health sector and the alignment with the NDP and the National Health Policy.

• To establish how those identified key priority areas of the health sector are planned for in the HSSIP

Current Sector Devel-opment Plan (SDP) 2015/16-2019/20

Ministry of Health • To ascertain if the Sector development plan feeds into the long and medium-term agenda of the health sector and To establish how those identified key priority areas of the health sector are planned for in the SDP.

Ministerial Policy Statement and Budget Framework paper for F/Y 2017/18

Ministry of Health • To establish and identify the planned activities to be undertaken by the sector for the period 2017/18 and funds allocated on the different key priority areas as identified in the NDPII, HSSIP, SDP and the National Health Policy

Annual Approved Budget Estimates 2017/18

Ministry of Health and other affiliated autono-mous institutions

• To ascertain the approved funds allocated to the key priority areas under the health sector.

Annual Sector Perfor-mance Report 2017/18

MoH and affiliated autonomous health sector institutions

• To establish the level of performance in achieving the set targets regarding the identified key priority areas under the health sector.

• To establish the levels of absorption in the health sector in regards to the key priority areas.

BMAU Reports and oth-er budget monitoring reports

Ministry of Health and MFPED

• To ascertain the frequency and scope of monitoring activities and the extent to which follow-up of recommendations for implementations of the projects are undertaken.

Contract Management records (certificates of work done, contracts, BOQs, minutes of Site meetings etc.)

Sampled health sector institutions

• To establish if the processes of contract management has been done with due regard to economy efficiency and effectiveness.

Procurement records (invitation for bids/ ad-verts, evaluation reports, contract award notices, etc.)


• To establish if the processes of procurement of contractors has been done with due regard to economy efficiency and effective-ness.

Financial Management records (bank state-ments, payment vouch-ers, claims etc.)


• To establish if the processes of financial management has been done with due regard to economy efficiency and effectiveness.


Appendix IV: Interviews conducted

Person/s Entity Purpose

Accounting officer, Principle assistant Secretary (PAS)

Undersecretary MOH

MOH • To understand the strategic goals and objectives of the ministry.

• To obtain an understanding of the structures put in place to aid the implementation of the activities under the key priority areas.

• To understand the roles and responsibilities played by the MoH and different entities in the implementation of the key priority activities.

• To understand the processes and key players in the implementation of the priority Programmes.

• To obtain the challenges faced and achievements made while implementing the key priority objectives and the way forward.

Accounting officer UBTS • To understand the strategic goals and objectives of UBTS.

• To obtain an understanding of the structures put in place to aid the implementation of the activities under the key priority areas.

• To understand the roles and responsibilities played by UBTS in the implementation of the key priority sector activities.

• To understand the processes and key players in the implementation of the priority Programmes in the sector.


Hospital Medical directors and Admin-istrators

National and Regional Referral Hospitals

• To understand the strategic goals and objectives of the NRHs and RRHs.

• To obtain an understanding of the structures put in place to aid the implementation of the activities under the key priority Programmes.

• To understand the roles and responsibilities played by the NRHs and RRHs in the implementation of the key priority activities.

• To understand the processes and key players in the implementation of the key priority Programmes.



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X (‘0

00’)

Rev

ised

bu

dget

UG

X (‘0

00’)

Am

ount

re

leas

edU

GX

(‘000

’)

Am

ount

Spe

ntU

GX

(‘000

’)A

chie

ved

Targ

et

by F

inan

cial

ye

ar e

nd

Vari

ance

Caus

es fo

r th

e va

rian

ces

MIN

ISTR

Y O

F H

EALT

H

Pro

ject

: 102

7 In

stitu

tiona

l su

ppor

t to

Min

istr

y of

H

ealt

h

0802

72: M

inis

try

of

heal

th H

eadq

uart

ers

reno

vate

d fo

llow

ing

the

fire

and

offic

e ac

-co

mm

odat

ion

mod

-er

nise

d

100%

full

reno

va-

tion

of th

e 3rd

-floo

r of

fices

1,54

2,00

01,

388,

000

1,38

8,00

01,

388,

000

100%

of t

he

thir

d 3rd

floo

r re

nova

ted

and

mod

erni

sed

Onl

y 40

% o

f the

bud

get-

ed/ r

elea

sed

fund

s w

ere

spen

t on

the

outp

ut (U

GX

553,

161,

416)

and

the

rest

, i.e

. 60%

was

div

erte

d to

unp

lann

ed a

ctiv

ities

. (U

GX.

830

,880

,584

)

Poo

r pl

anni

ng b

y M

an-

agem

ent

0802

75:

Pro

cure

men

t an

d di

stri

butio

n of

mot

or-

cycl

es

Two

mot

orcy

cles

pr

ocur

ed a

nd d

is-

trib

uted

20,0

0020

,000

20,0

0019

,764

Two

mot

orcy

cles

pr

ocur

ed a

nd

dist

ribu

ted

Nil

0802

75:

Pur

chas

e of

IT

Equi

pmen

t inc

ludi

ng

soft

war

e

Thre

e C

ompu

ters

fo

r th

e of

fice

of th

e P

S an

d Fi

nanc

e an

d A

dmin

pro

cure

dN

ew A

ir c

ondi

-tio

ner

proc

ured

and

in

stal

led

55,0

0055

,000

55,0

0055

,000

Thre

e C

ompu

t-er

s fo

r th

e of

fice

of th

e P

S an

d Fi

nanc

e an

d A

d-m

in p

rocu

red

New

Air

con

di-

tione

r pr

ocur

ed

and

inst

alle

d

Nil

0802

80:

Hos

pita

l con

stru

ctio

n/

reha

bilit

atio

n

No

Targ

ets

set f

or

the

outp

ut1,

800,

000

1,62

0,00

01,

620,

000

1,62

0,00

0N

/AN

/AFa

ilure

to s

et a

ppro

pria

te

targ

ets

and

indi

cato

rs

Mon

itori

ng, S

uper

vi-

sion

and

Eva

luat

ion

Hea

lth

syst

ems

mon

itore

d an

d ev

alua

ted

122,

000

122,

000

122,

000

121,

800

Hea

lth

syst

ems

mon

itore

d an

d ev

alua

ted

N/A

No

clea

r ta

rget

, ind

icat

ors

( fre

quen

cy o

f mon

itori

ng

and

repo

rtin

g)


Pro

ject

Out

put

Pla

nned

Tar

get f

or

the

Fin

anci

al y

ear

Bud

gete

d am

ount

UG

X (‘0

00’)

Rev

ised

bu

dget

UG

X (‘0

00’)

Am

ount

re

leas

edU

GX

(‘000

’)

Am

ount

Spe

ntU

GX

(‘000

’)A

chie

ved

Targ

et

by F

inan

cial

ye

ar e

nd

Vari

ance

Caus

es fo

r th

e va

rian

ces

Pro

ject

: 118

5 It

alia

n su

p-po

rt to

HSS

P

and

PR

DP

0802

82: 6

8 Co

nstr

uc-

tion

of s

taff

hou

ses

in

Kar

amoj

a re

gion

100%

com

plet

ion

of

the

68 s

taff

hou

ses

5,61

9,00

05,

619,

000

5,61

9,00

05,

619,

000

61.6

% c

ompl

eted

App

roxi

mat

ely

39.4

% n

ot

achi

eved

Don

or d

elay

ed to

dis

burs

e fu

nds

and

the

cont

rac-

tor

sto

p w

orki

ng s

ince

D

ecem

ber

2017

0802

01:

Mon

itori

ng, S

uper

vi-

sion

and

Eva

luat

ion

Mon

thly

mon

itori

ng

repo

rts

prod

uced

100,

000

100,

000

100,

000

100,

000

4 M

onito

ring

&

supe

rvis

ing

visi

ts

done

8 m

onth

ly m

onito

ring

vi

sits

not

don

e.Th

e nu

mbe

r of

vis

its r

e-du

ced

beca

use

the

cost

of

each

fiel

d vi

sit i

ncre

ased

in

clud

ing

invo

lvem

ent o

f Lo

cal l

eade

rs.

Pro

ject

: 118

7 Su

ppor

t to

Mul

ago

Hos

pita

l Re-

habi

litat

ion

0802

80: R

ehab

ilita

tion

and

equi

ppin

g of

low

er

Mul

ago

100%

com

plet

ion

of r

ehab

ilita

tion

of

low

er m

ulag

o

950,

000

855,

000

855,

000

855,

000

98%

of L

ower

m

ulag

o re

habi

li-ta

ted

2% n

ot a

chie

ved

Pro

ject

: 124

3 R

ehab

ilita

-tio

n an

d co

nstr

uctio

n of

Gen

eral

ho

spita

ls

0802

80: r

ehab

ilita

tion

of e

quip

ping

of K

awol

o an

d B

usol

we

hosp

itals

50%

of w

orks

com

-pl

etio

n on

Kaw

olo

and

Bus

olw

e

19,2

82,0

0019

,282

,000

4,02

0,00

03,

726,

879

57%

on

Kaw

olo

com

plet

ed.

0% o

n B

usol

we

com

plet

ed O

ver-

all c

ompl

etio

n (2

8.5%

)

21.5

% n

ot a

chie

ved

Wor

ks o

n B

usol

we

have

no

t yet

com

men

ced.

No

cont

ract

for

wor

ks. F

unds

no

t eno

ugh

to c

over

the

scop

e of

wor

ks n

eede

d,

0802

01:

Mon

itori

ng, S

uper

vi-

sion

and

Eva

luat

ion

Cons

truc

tion

wor

ks

supe

rvis

ed

80,0

0080

,000

80,0

0079

,930

Ann

ual p

roje

ct

supe

rvis

ion

re-

port

pro

duce

d

Ther

e is

no

outp

ut

indi

cato

r or

freq

uenc

y of

m

onito

ring

sho

wn

in th

e ta

rget

set

Ther

e is

no

outp

ut

indi

cato

r or

freq

uenc

y of

m

onito

ring

sho

wn

in th

e ta

rget

set


Pro

ject

Out

put

Pla

nned

Tar

get f

or

the

Fin

anci

al y

ear

Bud

gete

d am

ount

UG

X (‘0

00’)

Rev

ised

bu

dget

UG

X (‘0

00’)

Am

ount

re

leas

edU

GX

(‘000

’)

Am

ount

Spe

ntU

GX

(‘000

’)A

chie

ved

Targ

et

by F

inan

cial

ye

ar e

nd

Vari

ance

Caus

es fo

r th

e va

rian

ces

Pro

ject

: 134

4 R

enov

a-tio

n an

d Eq

uipp

ing

of K

ayun

ga

and

Yum

be

Gen

eral

H

ospi

tals

0802

77: m

edic

al

equi

pmen

t for

full

equi

ppin

g of

Kay

unga

an

d Yu

mbe

hos

pita

ls

fully

equ

ippi

ng o

f ho

spita

ls

6,70

0,00

06,

700,

000

00

Non

eN

o eq

uipm

ent p

rocu

red

for

the

hosp

itals

The

set t

arge

t was

unr

e-al

istic

sin

ce th

e m

edic

al

equi

pmen

t cou

ld o

nly

be

proc

ured

aft

er c

ompl

e-tio

n of

ren

ovat

ion

and

expa

nsio

n of

the

hosp

ital.

Ther

efor

e th

e do

nor

Coul

d no

t rel

ease

fund

s fo

r th

e eq

uipm

ent a

s pl

anne

d.

0802

80: 3

0% c

ivil

wor

ks fo

r re

habi

lita-

tion

and

expa

nsio

n of

K

ayun

ga a

nd Y

umbe

H

ospi

tals

com

plet

ed

30%

of c

ivil

wor

ks

com

plet

ion

27,8

85,0

0027

,885

,000

19,3

22,6

6721

,665

,067

15%

com

plet

ion

for

Kay

unga

and

7%

com

plet

ion

for

Yum

be (O

ver-

all c

ompl

etio

n 11

%)

19%

not

ach

ieve

d P

rocu

rem

ent d

elay

s.Ex

cess

fund

s sp

ent o

ver

the

rele

ase

(2,3

42,3

99)

wer

e di

vers

ions

from

ot

her

outp

uts

0802

01:

Mon

itori

ng, S

uper

vi-

sion

and

Eva

luat

ion

Twel

ve s

ite m

eet-

ings

hel

dCo

ntra

ct im

plem

en-

tatio

n m

onito

red

300,

820

282,

330

282,

330

282,

330

Twel

ve s

ite

mee

tings

hel

d fo

r ea

ch s

ite

and

cont

ract

im

plem

enta

tion

mon

itore

d

No

mon

itori

ng r

epor

ts

from

MoH

Sta

ff

Pro

ject

: 13

94 r

egio

nal

hosp

ital f

or

paed

iatr

ic

surg

ery

0802

80: c

ompl

etio

n of

50

% o

f civ

il w

orks

50

% c

ompl

etio

n of

w

orks

800,

000

9,42

8,03

99,

428,

039

7,22

7,11

240

% c

ompl

etio

n10

% n

ot a

chie

ved

Del

ays

in c

lear

ance

of

impo

rted

mat

eria

ls

Del

ays

in r

elea

se o

f co

unte

rpar

t fun

ding

, and

co

ntin

uous

req

uest

for

min

or c

hang

es in

the

desi

gns

by th

e do

nors

.D

iver

sion

of f

unds

(2

,200

,887

)

0802

01:

Mon

itori

ng, S

uper

vi-

sion

and

eva

luat

ion

Cons

truc

tion

of th

e ho

spita

l sup

ervi

sed

170,

000

170,

000

170,

000

169,

987

Mon

itori

ng w

as

only

don

e si

nce

Febr

uary

201

8

Wor

ks im

plem

ente

d in

th

e fir

st 3

qua

rter

s no

t m

onito

red

Ther

e is

no

outp

ut

indi

cato

r or

freq

uenc

y of

m

onito

ring

sho

wn

in th

e


Pro

ject

Out

put

Pla

nned

Tar

get f

or

the

Fin

anci

al y

ear

Bud

gete

d am

ount

UG

X (‘0

00’)

Rev

ised

bu

dget

UG

X (‘0

00’)

Am

ount

re

leas

edU

GX

(‘000

’)

Am

ount

Spe

ntU

GX

(‘000

’)A

chie

ved

Targ

et

by F

inan

cial

ye

ar e

nd

Vari

ance

Caus

es fo

r th

e va

rian

ces

Pro

ject

: 14

40 U

gand

a R

epro

duct

ive

Mat

erni

ty

and

Child

H

ealt

h Se

rvic

es Im

-pr

ovem

ent

Pro

ject

0802

80: P

rocu

rem

ent

of m

otor

veh

icle

s fo

r su

ppor

t sup

ervi

sion

21 m

otor

veh

icle

s pr

ocur

ed

2,84

7,33

02,

847,

330

2,84

7,33

02,

847,

330

Non

eN

o ve

hicl

es p

rocu

red

duri

ng th

e ye

arFu

nds

dive

rted

to p

rocu

re

med

ical

equ

ipm

ent

0802

76: P

rocu

rem

ent

of b

irth

, dea

th m

obile

se

rvic

es p

rocu

red

for

NIR

A

Firm

for

deve

lop-

men

t of b

irth

and

de

ath

regi

stra

tion

proc

ured

2,69

5,47

22,

695,

472

00

Non

e Te

nder

to b

e re

-ad

vert

ised

Fu

nds

allo

cate

d no

t en

ough

to e

xecu

te th

e sc

ope

of w

orks

. The

pr

ocur

emen

t had

to b

e re

-ten

dere

d.Th

e bu

dget

s w

ere

over

ly

ambi

tious

, tar

gets

unr

e-al

istic

.

0802

77: P

rocu

rem

ent

of c

ritic

al r

epro

duct

ive

equi

pmen

t

Full

proc

urem

ent

of c

ritic

al m

edic

al

equi

pmen

t

4,00

0,00

04,

000,

000

00

Non

eN

o eq

uipm

ent w

as

proc

ured

Man

agem

ent h

adn’

t don

e th

e ne

eds

asse

ssm

ent o

n th

e in

tend

ed b

enefi

ting

heal

th c

are

inst

itutio

ns.

0802

81: M

ater

nity

un

its c

onst

ruct

ion

in th

e se

lect

ed lo

cal

gove

rnm

ent’s

hea

lth

cent

res

Cons

truc

tion

of

mat

erni

ty u

nits

in

sele

cted

hea

lth

cent

res

11,5

22,1

9511

,522

,195

00

Non

eN

o co

nstr

uctio

ns d

one

A n

eeds

ass

essm

ent

hadn

’t be

en d

one.

Ther

e w

ere

no a

ppro

ved

desi

gns

for

the

proj

ect


Pro

ject

Out

put

Pla

nned

Tar

get f

or

the

Fin

anci

al y

ear

Bud

gete

d am

ount

UG

X (‘0

00’)

Rev

ised

bu

dget

UG

X (‘0

00’)

Am

ount

re

leas

edU

GX

(‘000

’)

Am

ount

Spe

ntU

GX

(‘000

’)A

chie

ved

Targ

et

by F

inan

cial

ye

ar e

nd

Vari

ance

Caus

es fo

r th

e va

rian

ces

Pro

ject

: 022

0 gl

obal

Fun

d fo

r A

ids,

TB

an

d M

alar

ia

0805

72: C

onst

ruct

ion

of m

edic

ines

war

e-ho

use

in K

ajja

nsi

% c

ompl

etio

n of

the

med

icin

e w

are-

hous

e

48,2

14,7

8848

,214

,788

NA

NA

NA

Ther

e w

as n

o ta

rget

se

t for

the

outp

ut in

the

wor

k pl

an

Out

put n

ot im

plem

ente

d by

MoH

0805

75: P

rocu

re 7

de-

liver

y tr

ucks

for

NM

S an

d JM

S 4

film

Van

s,

Stat

ion

Wag

on, 2

car

s fo

r M

&E

offic

ers

7 de

liver

y tr

ucks

pr

ocur

ed4

film

van

s pr

o-cu

red

2 ve

hicl

es p

rocu

red

3,41

5,89

63,

415,

896

3,41

5,89

63,

415,

896

2 fil

m v

ans

deliv

-er

ed83

mot

orcy

cles

pr

ocur

ed2

stat

ion

wag

ons

proc

ured

1 do

uble

cab

in

proc

ured

2 fil

m v

ans

not p

rocu

red

No

plan

for

mot

orcy

cles

1 do

uble

cab

in p

rocu

red

not i

n th

e w

ork

plan

.83

mot

orcy

cles

pro

cure

d no

t in

the

wor

k pl

an

Pro

cure

men

t del

ays

0805

77:

proc

ure-

men

t of A

utoc

lave

s,

Gen

eXpe

rt M

achi

nes,

M

icro

scop

es, F

orkl

ift,

med

icin

es s

helv

es

and

rack

s, m

edic

ines

bo

xes,

x-r

ay m

achi

nes

150

aut

ocla

ves

proc

ured

23

9 G

enex

pert

ma-

chin

es p

rocu

red

No.

of M

icro

scop

e pr

ocur

edN

o of

Xra

ys p

ro-

cure

dM

edic

ine

boxe

s m

ade

Shel

ves

cons

truc

ted

Fork

lift p

rocu

red

31,8

57,1

3231

,857

,132

31,8

57,1

3231

,857

,132

150

auto

clav

es

proc

ured

Med

icin

e bo

xes

mad

eM

edic

ine

shel

ves

cons

truc

ted

Fork

lift

veh

icle

pr

ocur

ed

The

x-ra

ys a

nd m

icro

-sc

opes

are

bei

ng p

rocu

red

thro

ugh

pool

ed p

rocu

re-

men

t mec

hani

sms

of th

e G

loba

l Fun

d w

hich

hav

e lo

nger

lead

tim

es. T

he

proc

urem

ent i

s on

cou

rse

and

deliv

ery

is s

ched

uled

fo

r M

arch

201

9.


Pro

ject

Out

put

Pla

nned

Tar

get f

or

the

Fin

anci

al y

ear

Bud

gete

d am

ount

UG

X (‘0

00’)

Rev

ised

bu

dget

UG

X (‘0

00’)

Am

ount

re

leas

edU

GX

(‘000

’)

Am

ount

Spe

ntU

GX

(‘000

’)A

chie

ved

Targ

et

by F

inan

cial

ye

ar e

nd

Vari

ance

Caus

es fo

r th

e va

rian

ces

1436

: Gav

i va

ccin

es a

nd

Hea

lth

sec-

tor

Dev

elop

-m

ent p

lan

supp

ort

0805

03:

Mon

itori

ng a

nd e

valu

-at

ion

capa

city

im-

prov

emen

t

No

targ

et s

et

425,

217

425,

217

207,

173

207,

173

No

outp

ut

achi

eved

Exte

rnal

fund

s w

ere

not

rele

ased

to im

plem

ent t

he

plan

ned

capi

tal o

utpu

ts.

Ther

efor

e, m

onito

ring

co

uldn

’t be

car

ried

. (th

e G

oU h

ad o

utst

andi

ng

issu

es to

hav

e th

e M

oU

final

ized

with

the

dono

r)

0805

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vent

ive

and

cura

-tiv

e M

edic

al s

uppl

ies

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cure

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0 H

PV

dose

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362,

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ses

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t for

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of H

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of

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ta d

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ildin

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out

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ase

of

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or V

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r tr

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out

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quip

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e to

out

stan

ding

is

sue

in th

e M

oU

MU

LAG

O H

OSP

ITA

L CO

MP

LEX


Pro

ject

Out

put

Pla

nned

Tar

get f

or

the

Fin

anci

al y

ear

Bud

gete

d am

ount

UG

X (‘0

00’)

Rev

ised

bu

dget

UG

X (‘0

00’)

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ount

re

leas

edU

GX

(‘000

’)

Am

ount

Spe

ntU

GX

(‘000

’)A

chie

ved

Targ

et

by F

inan

cial

ye

ar e

nd

Vari

ance

Caus

es fo

r th

e va

rian

ces

Out

put:

84

OP

D a

nd

othe

r w

ard

cons

truc

-tio

n an

d re

habi

litat

ion

Dem

oliti

on a

nd R

ebui

ld-

ing

of O

utpa

tient

dep

art-

men

t and

I.C.

U In

trod

uc-

tion

of a

n ad

ditio

nal F

loor

on

the

thea

tre

exte

nsio

n B

lock

K D

emol

ition

of

Mor

tuar

y an

d Co

nstr

uc-

tion

of th

e ne

w p

atho

logy

de

part

men

t (bl

ock

H)

Org

an T

rans

plan

t Uni

t on

Blo

ck A

leve

l 6Co

nstr

uctio

n of

an

orga

n tr

ansp

lant

uni

t in

final

st

ages

, rem

odel

ling

of w

ards

, exp

ansi

on o

f th

eatr

es;(c

entr

alis

ed o

p-er

atin

g th

eatr

e, A

&E,

ICU

) m

achi

nery

and

Med

ical

eq

uipm

ent h

ave

been

ac

quir

ed, a

nd in

stal

latio

n is

ong

oing

22,0

20,0

0022

,170

,000

22,1

70,0

00

22,1

70,0

00Co

nstr

uctio

n of

an

orga

n tr

ansp

lant

uni

tin

fina

l sta

ges,

re-

mod

ellin

g of

war

ds,

expa

nsio

n of

th

eatr

es;(c

entr

alis

edop

erat

ing

thea

tre,

A

&E,

ICU

) mac

hine

ryan

d M

edic

al e

quip

-m

ent h

ave

been

acqu

ired

and

inst

alla

-tio

n is

ong

oing

UG

X 14

,203

,379

,232

wer

e us

ed to

fina

nce

othe

r ca

pita

l dev

elop

men

t ac

tiviti

es

Fund

s w

orth

UG

X 14

,203

,379

,232

wer

e di

vert

ed

UB

TS

Safe

Blo

od

Pro

visi

onCo

llect

ion

of b

lood

24

0,00

0 un

it of

bl

ood

colle

cted

300,

000

bloo

d do

-no

rs r

ecru

ited

240,

000

unit

of

bloo

d co

llect

ed

test

ed

3,80

0,00

07,

040,

000

7,04

0,00

07,

040,

000

209,

633

units

of

bloo

d co

llect

ed

No

achi

eved

ta

rget

s on

blo

od

dono

r re

crui

t-m

ent a

nd u

nit

of b

lood

test

ed

repo

rted

30,3

67 u

nits

of b

lood

not

co

llect

edIn

adeq

uate

test

Kits

and

bl

ood

bags

in Q

1 an

d Q

2

Pur

chas

e of

mot

or

Vehi

cle

and

othe

r tr

ansp

ort E

quip

men

t

1 bl

ood

colle

ctio

n va

n pr

ocur

ed25

0,00

025

0,00

025

0,00

023

6,45

5P

urch

ased

I bl

ood

colle

ctio

n va

n


Pro

ject

Out

put

Pla

nned

Tar

get f

or

the

Fin

anci

al y

ear

Bud

gete

d am

ount

UG

X (‘0

00’)

Rev

ised

bu

dget

UG

X (‘0

00’)

Am

ount

re

leas

edU

GX

(‘000

’)

Am

ount

Spe

ntU

GX

(‘000

’)A

chie

ved

Targ

et

by F

inan

cial

ye

ar e

nd

Vari

ance

Caus

es fo

r th

e va

rian

ces

Pur

chas

e of

offi

ce a

nd

ICT

equi

pmen

t P

urch

ase

of m

a-ch

iner

y an

d eq

uip-

men

t, an

d CC

TV

100,

000

100,

000

100,

000

100,

00P

rocu

red

CCTV

ca

mer

a sy

stem

fo

r N

akas

ero

bloo

d ba

nk, a

nd

cano

n ph

oto-

copi

er

The

offic

e eq

uipm

ent t

o be

pro

cure

d w

ere

not

item

ized

in th

e W

ork

plan

The

offic

e eq

uipm

ent t

o be

pr

ocur

ed w

ere

not i

tem

-iz

ed in

the

Wor

k pl

an

Pur

chas

e of

offi

ce a

nd

Res

iden

tial f

urni

ture

an

d fit

tings

Cate

gory

and

num

-be

r of

offi

ce fu

rni-

ture

not

spe

cifie

d

20,0

0020

,000

20,0

0019

,800

Cate

gory

and

nu

mbe

r of

offi

ce

furn

iture

not

sp

ecifi

ed

Cate

gory

and

num

ber

of o

ffice

furn

iture

not

sp

ecifi

ed

Cate

gory

and

num

ber

of o

ffice

furn

iture

not

sp

ecifi

ed

Sub

Pro

gram

me

02

outp

ut: 0

8530

1 A

d-m

inis

trat

ive

supp

ort

serv

ices

-Man

agem

ent o

f fac

ili-

ties

-Rep

lace

men

t of o

ld

vehi

cles

-Mai

nten

ance

of l

abo-

rato

ry e

quip

men

t -R

ecru

itmen

t

No

targ

ets

wer

e se

t fo

r ea

ch a

ctiv

ity1,

000,

000

1,00

0,00

01,

000,

000

1,00

0,00

0M

anag

emen

t of

faci

litie

s

som

e la

bora

tory

equ

ip-

men

t mai

ntai

ned

and

one

old

vehi

cle

repl

aced

Man

agem

ent e

xpla

ined

th

at th

e fu

nds

allo

cate

d w

eren

’t su

ffici

ent t

o im

-pl

emen

t all

the

plan

ned

activ

ities

.

Sub

Pro

gram

me

01:

Adm

inis

trat

ive

Sup-

port

ser

vice

sCo

nstr

uctio

n of

re-

gion

al b

lood

ban

ks. (

co

mpl

etio

n of

Con

-ce

pts,

pro

posa

ls a

nd

feas

ibili

ty s

tudi

es)

Mai

nten

ance

of e

xist

-in

g fa

cilit

ies.

-Sup

ervi

sion

and

cl

inic

al in

terf

ace

to

hosp

ital c

linic

ians

and

ad

min

istr

ator

s.-R

ecru

itmen

t of s

taff.

Cons

truc

tion

of r

e-gi

onal

blo

od b

anks

. ( c

ompl

etio

n of

Co

ncep

ts, p

ropo

s-al

s an

d fe

asib

ility

st

udie

s)M

aint

enan

ce o

f ex

istin

g fa

cilit

ies.

-Sup

ervi

sion

and

cl

inic

al in

terf

ace

to

hosp

ital c

linic

ians

an

d ad

min

istr

ator

s.-R

ecru

itmen

t of

staf

f.

4,00

1,16

84,

001,

168

3,99

3,16

83,

663,

834

Supe

rvis

ion

and

clin

ical

inte

r-fa

ce to

hos

pita

l cl

inic

ians

and

ad

min

istr

ator

s.M

aint

enan

ce o

f ex

istin

g fa

cili-

ties.

-Rec

ruitm

ent o

f st

aff.

Conc

epts

, pro

posa

ls a

nd

feas

ibili

ty s

tudi

es n

ot

com

plet

ed

Insu

ffici

ent b

udge

t al-

loca

tions


Pro

ject

Out

put

Pla

nned

Tar

get f

or

the

Fin

anci

al y

ear

Bud

gete

d am

ount

UG

X (‘0

00’)

Rev

ised

bu

dget

UG

X (‘0

00’)

Am

ount

re

leas

edU

GX

(‘000

’)

Am

ount

Spe

ntU

GX

(‘000

’)A

chie

ved

Targ

et

by F

inan

cial

ye

ar e

nd

Vari

ance

Caus

es fo

r th

e va

rian

ces

GU

LU R

RH

1004

: Gul

u R

ehab

ilita

-tio

n R

efer

ral

Hos

pita

l

Cons

truc

tion

of 5

4 U

nit

staf

f hou

ses

Com

plet

ion

of th

e se

cond

sla

b an

d In

itiat

ion

of th

e 3rd

sl

ab

1,33

8,00

01,

338,

000

1,33

8,00

01,

191,

500

The

seco

nd s

lab

was

not

com

-pl

eted

, and

the

3rd s

lab

hadn

’t be

en in

itiat

ed.

(Ove

rall

achi

eve-

men

t app

rox.

55

%)

The

2nd s

lab

not y

et

com

plet

ed 3

rd s

lab

had

not b

een

initi

ated

The

slow

pro

gres

s of

w

orks

was

due

to th

e lim

ited

annu

al fu

nds

allo

cate

d to

the

proj

ect b

y m

inis

try

of fi

nanc

e.

Par

t of t

hese

fund

s w

ere

dive

rted

(UG

X 14

6,50

0,00

0)

Dem

oliti

on o

f the

old

ra

diol

ogy

build

ing

Co

mpl

ete

dem

oli-

tion

of th

e ol

d ra

di-

olog

y bu

ildin

g an

d re

mov

al o

f deb

ris

50,0

0050

,000

50,0

0048

,000

Old

rad

iol-

ogy

build

ing

dem

olis

hed,

th

e de

bris

not

re

mov

ed (o

vera

ll ac

hiev

emen

t ap-

prox

.65%

)

The

debr

is w

as n

ot

rem

oved

Poo

r co

ntra

ct m

anag

e-m

ent

1468

: Ins

ti-tu

tiona

l sup

-po

rt to

Gul

u R

egio

nal

refe

rral

ho

spita

l.

Pro

cure

men

t of a

s-so

rted

med

ical

equ

ip-

men

t

Pro

cure

BP

mon

itor

mac

hine

s an

d A

CB

C m

achi

ne w

ith it

re

agen

ts

100,

000

100,

000

100,

000

98,7

00P

rocu

red

BP

m

onito

r m

a-ch

ines

and

A

CBC

mac

hine

w

ith it

rea

gent

s

Nil

The

outp

ut w

as fu

lly

achi

eved

FOR

T P

OR

TAL

RR

H

0856

: Re-

gion

al R

efer

-ra

l Hos

pita

l Se

rvic

es

0857

2: G

over

nmen

t B

uild

ings

and

Adm

in-

istr

ativ

e In

fras

truc

ture

Gov

ernm

ent B

uild

-in

gs a

nd a

dmin

is-

trat

ion

build

ings

mai

ntai

ned

incl

ud-

ing

sani

tatio

n

39,5

72,0

0039

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,000

39,5

72,0

0037

,200

,000

Adm

inis

trat

ion

build

ings

mai

n-ta

ined

,re

gula

r cl

eani

ng

and

sani

tatio

n se

rvic

esCo

ntra

cted

. In

fect

ion

prev

en-

tion

and

cont

rol

mee

tings

in a

nd

outs

ide

the

hos-

pita

l and

hel

d.

No

targ

ets

with

per

for-

man

ce in

dica

tors

wer

e se

t in

the

annu

al w

ork

plan

to g

uide

the

exte

nt

of a

chie

vem

ent o

f the

pl

anne

d ou

tput

s. o

ut o

f th

e bu

dget

ed a

mou

nt

UG

X, 3

7,20

0,00

0 w

as

spen

t on

the

outp

ut

henc

e a

bala

nce

of U

GX

2,37

2,00

0

It w

as a

n ov

ersi

ght d

urin

g pl

anni

ng th

at m

anag

e-m

ent d

id n

ot s

et th

e ta

rget

s an

d in

dica

tors

to

mea

sure

per

form

ance

of

the

outp

ut. T

he v

aria

nce

of U

GX

2,37

2,00

0 w

as

refle

cted

as

unsp

ent b

al-

ance

in th

e pe

rfor

man

ce

repo

rt.


Pro

ject

Out

put

Pla

nned

Tar

get f

or

the

Fin

anci

al y

ear

Bud

gete

d am

ount

UG

X (‘0

00’)

Rev

ised

bu

dget

UG

X (‘0

00’)

Am

ount

re

leas

edU

GX

(‘000

’)

Am

ount

Spe

ntU

GX

(‘000

’)A

chie

ved

Targ

et

by F

inan

cial

ye

ar e

nd

Vari

ance

Caus

es fo

r th

e va

rian

ces

0858

1:

Staf

f hou

ses

cons

truc

-tio

n an

d re

habi

litat

ion

Engi

neer

ing

and

desi

gn w

orks

st

arte

d. M

onito

ring

and

supe

rvis

ion

of

cons

truc

tion

wor

ks.

Staf

f hou

ses

con-

stru

cted

, reh

abili

-ta

ted,

mai

ntai

ned

incl

udin

gsa

nita

tion

882,

428,

000

882,

428,

000

882,

428,

000

54,8

93,0

00Co

ntin

uatio

n of

wor

ks o

f a

16-u

nit s

taff

ho

stel

. On-

goin

g m

onito

ring

and

su

perv

isio

n of

co

nstr

uctio

n of

w

orks

No

perf

orm

ance

targ

et

was

set

for

the

outp

ut

(per

cent

age

of c

ompl

e-tio

n fo

r th

e FY

) and

the

freq

uenc

y of

mon

itori

ng

to g

uide

the

asse

ssm

ent

of p

erfo

rman

ce. O

ut o

f th

e ap

prov

ed b

udge

t of

UG

X 88

2,42

8,00

0,

the

hosp

ital s

pent

UG

X 54

,893

,000

hen

ce a

ba

lanc

e of

UG

X 82

7,53

5,00

0

Failu

re to

set

per

form

ance

ta

rget

s an

d pe

rfor

man

ce

indi

cato

rs w

as d

elib

erat

e by

man

agem

ent.

The

vari

-an

ce b

etw

een

the

budg

et

and

spen

t fun

ds w

as a

s a

resu

lt o

f mis

s re

port

ing.

A

naly

sis

of th

e pa

ymen

t fil

e in

dica

ted

that

UG

X 86

0,42

8,34

3 w

as s

pent

.

0858

5: P

urch

ase

of

Med

ical

Equ

ipm

ent

Ass

orte

d m

edic

al

equi

pmen

t pro

-cu

red

138,

000,

000

138,

000,

000

138,

000,

000

137,

446,

000

Ass

orte

d eq

uip-

men

t pro

cure

d fo

r su

rger

y an

d pr

ivat

e w

ards

as

wel

l as

shel

ves

for

libra

ry a

nd

the

reso

urce

ce

ntre

.

The

annu

al w

ork

plan

do

es n

ot d

etai

l spe

cific

as

sort

ed m

edic

al e

quip

-m

ent t

o be

pro

cure

d an

d un

it co

sts

atta

ched

to

eac

h to

just

ify th

e bu

dget

am

ount

for

the

Out

put.

UG

X 55

4,00

0 w

as

the

vari

ance

bet

wee

n bu

dget

and

spe

nt.

Gap

s in

pla

nnin

g fo

r ho

spita

l ser

vice

s su

ch a

s co

stin

g an

d bu

dget

ing

for

activ

ities

e.g

. the

bal

ance

be

twee

n bu

dget

and

spe

nt

of U

GX

554,

000

coul

d ha

ve

been

as

a re

sult

of o

ver

budg

etin

g.

MA

SAK

A R

RH

01:

Mas

aka

Ref

erra

l H

ospi

tal

Serv

ices

04 D

iagn

ostic

ser

vice

s55

3,90

0 la

bora

tory

te

sts

carr

ied

out

13,9

15 u

ltra

sou

nd

scan

s m

ade

5,94

9 x-

ray

exam

i-na

tions

mad

e

116,

000

116,

000

116,

000

113,

500

Labo

rato

ry

test

s do

ne w

ere

304,

805.

Ult

ra

soun

d ex

ami-

natio

ns w

ere

13,9

53. X

-Ray

ex-

amin

atio

ns d

one

wer

e 37

84.

Blo

od tr

ansf

u-si

ons

wer

e 5,

374

249,

095

labo

rato

ry te

sts

not d

one

2,16

5 x-

rays

not

don

e

Lab.

test

s de

clin

ed b

e-ca

use

of la

ck o

f rea

gent

s.

X-ra

ys ta

rget

s w

ere

not

met

due

to in

adeq

uate

and

in

appr

opri

ate

supp

lies

of

x-ra

y fil

ms

by N

atio

nal

Med

ical

sto

res.

1004

: M

asak

a R

ehab

ilita

-tio

n R

efer

ral

Hos

pita

l

Out

put 0

8568

1: S

taff

ho

uses

con

stru

ctio

n an

d re

habi

litat

ion

(

Foun

datio

n fo

r al

l th

e 40

uni

ts s

taff

ho

stel

com

plet

ed1

bloc

k of

the

staf

f ho

stel

com

plet

ed

500,

000

500,

000

500,

000

474,

860

Raf

t fou

nda-

tion

com

plet

ed

with

ste

el a

nd

conc

rete

.

No

sing

le b

lock

on

staf

f ho

use

com

plet

edFu

ndin

g fo

r th

is p

roje

ct is

no

t goo

d an

d as

a r

esul

t, th

e co

ntra

ctor

onl

y w

orks

de

pend

ing

on a

vaila

bilit

y of

fund

s.


Pro

ject

Out

put

Pla

nned

Tar

get f

or

the

Fin

anci

al y

ear

Bud

gete

d am

ount

UG

X (‘0

00’)

Rev

ised

bu

dget

UG

X (‘0

00’)

Am

ount

re

leas

edU

GX

(‘000

’)

Am

ount

Spe

ntU

GX

(‘000

’)A

chie

ved

Targ

et

by F

inan

cial

ye

ar e

nd

Vari

ance

Caus

es fo

r th

e va

rian

ces

Out

put 0

8568

2: M

ater

-ni

ty w

ard

cons

truc

tion

and

reha

bilit

atio

n

Com

plet

ing

the

cons

truc

tion

of th

e su

per

stru

ctur

e of

mat

er-

nity

and

Chi

ldre

n’s

com

plex

1,55

8,00

01,

558,

000

1,55

8,00

01,

027,

655

Blo

ck w

orks

, pil-

lars

for

the

roof

, el

ectr

ical

wor

ks,

Cast

ing

of th

e fo

urth

floo

r, fi

rst

plum

bing

fixes

insi

de,

mas

onry

wor

ks,

star

ted

on th

e ro

ofing

of t

he

stru

ctur

e.

MB

ALE

RR

H

1004

: Mba

le

Reh

abili

ta-

tion

Ref

erra

l H

ospi

tal

0856

83: O

PD

and

oth

er

war

d co

nstr

uctio

n an

d re

habi

litat

ion

(Con

-st

ruct

ion

of s

urgi

cal

and

canc

er w

ard)

No

targ

et s

et fo

r th

e ye

ar in

the

wor

k pl

an

2,00

0,00

02,

000,

000

2,00

0,00

01,

999,

666

Wor

ks fo

r fir

st

floor

wer

e do

ne,

cast

ing

of th

e w

ing

of

the

thea

tre

bloc

k w

as a

lso

done

, an

d al

lco

lum

ns o

f the

se

cond

floo

r of

th

e w

ard

bloc

k w

ere

done

.

Not

abl

e to

asc

erta

in

Man

agem

ent d

id n

ot s

et

targ

ets

to a

chie

ve fo

r th

e ye

ar.

1478

: In-

stitu

tiona

l su

ppor

t to

Mba

le R

e-gi

onal

ref

er-

ral h

ospi

tal.

0856

83: O

ther

str

uc-

ture

s ( C

onst

ruct

ion

an

d in

stal

latio

n of

a

new

inci

nera

tor

and

R

enov

atio

n of

acu

te

care

uni

t

100%

com

plet

ion

of

Inci

nera

tor

hous

e,

cons

truc

tion

and

inst

alla

tion

of th

e in

cine

rato

r an

d pu

t to

use

.R

enov

ated

acu

te

care

uni

t

500,

000

500,

000

500,

000

404,

209

Inci

nera

tor

hous

e c

ompl

et-

ed, I

ncin

erat

or

inst

alle

d

The

inci

nera

tor

not y

et in

us

e by

yea

r en

d (2

017/

18)

Ther

e w

as n

eed

to c

hang

e th

e ro

of s

truc

ture

of t

he

inci

nera

tor

hous

e fr

om

woo

d as

was

in th

e or

igi-

nal d

esig

n to

met

al

8568

3: M

achi

nery

and

Eq

uipm

ent (

Pur

chas

e of

hos

pita

l veh

icle

Pro

cure

one

dou

ble

cabi

n pi

ckup

20

0,00

020

0,42

820

0,42

817

6,50

0O

ne d

oubl

e ca

bin

pick

up p

rocu

red

Nil

No

vari

ance


Pro

ject

Out

put

Pla

nned

Tar

get f

or

the

Fin

anci

al y

ear

Bud

gete

d am

ount

UG

X (‘0

00’)

Rev

ised

bu

dget

UG

X (‘0

00’)

Am

ount

re

leas

edU

GX

(‘000

’)

Am

ount

Spe

ntU

GX

(‘000

’)A

chie

ved

Targ

et

by F

inan

cial

ye

ar e

nd

Vari

ance

Caus

es fo

r th

e va

rian

ces

8568

3: O

ffice

Equ

ip-

men

t P

rocu

re

(a

ssor

ted

offic

e eq

uipm

ent)

130,

000

130,

000

130,

000

126,

500

Pro

cure

d an

d re

ceiv

ed O

ffice

Eq

uipm

ent w

orth

U

GX

126,

500,

000

(Hea

vy d

uty

phot

ocop

ier

UG

X 21

,562

,000

, Offi

ce

chai

rs, c

abin

s an

d de

sks

UG

X 20

,314

,343

, 21

lapt

op c

om-

pute

rs U

GX

30,9

12,8

00, b

uck-

ets

for

offic

e us

e U

GX

16,8

87,5

00

and

offic

e eq

uip-

men

t cos

ting

UG

X 3,

505,

000

Nil

No

vari

ance

8568

5: M

edic

al E

quip

-m

ent

Ass

orte

d m

edic

al

227,

571

227,

571

227,

571

227,

359

Pro

cure

d (a

utoc

lave

s,

mat

tres

ses,

and

ot

her

asso

rted

m

edic

al e

quip

-m

ent)

Not

abl

e to

asc

erta

in

Man

agem

ent d

id n

ot

item

ize

all t

he r

elev

ant

equi

pmen

t tha

t was

to b

e pr

ocur

ed d

urin

g th

e ye

ar

in th

e w

ork

plan

.

MB

AR

AR

A R

RH


Pro

ject

Out

put

Pla

nned

Tar

get f

or

the

Fin

anci

al y

ear

Bud

gete

d am

ount

UG

X (‘0

00’)

Rev

ised

bu

dget

UG

X (‘0

00’)

Am

ount

re

leas

edU

GX

(‘000

’)

Am

ount

Spe

ntU

GX

(‘000

’)A

chie

ved

Targ

et

by F

inan

cial

ye

ar e

nd

Vari

ance

Caus

es fo

r th

e va

rian

ces

Pro

gram

me:

08

56 R

e-gi

onal

Ref

er-

ral H

ospi

tal

Serv

ices

0857

5: P

urch

ase

of

mot

or v

ehic

le a

nd

othe

r tr

ansp

ort e

quip

-m

ent

Pur

chas

e of

a

tran

spor

t equ

ip-

men

t- T

o bu

y a

30 s

eate

r va

n fo

r tr

ansp

ortin

g st

aff

mem

bers

dur

ing

diff

eren

t offi

cial

fu

nctio

ns

400,

000

400,

000

400,

000

400,

000

A 3

0 se

ater

van

fo

r tr

ansp

ortin

g st

aff m

embe

rs

duri

ng d

iffer

ent

offic

ial f

unct

ions

pr

ocur

ed

Not

all

fund

s w

ere

spen

t on

the

plan

ned

outp

ut. U

GX

79,5

20,9

22

was

div

erte

d to

pay

for

outs

tand

ing

bala

nce

on th

e pu

rcha

se o

f th

e m

edic

al d

irec

tor’

s ve

hicl

e pr

ocur

ed in

th

e FY

201

6/20

17. U

GX

320,

479,

078

was

spe

nt

on th

e pl

anne

d ou

tput

le

avin

g an

uns

pent

ba

lanc

e of

UG

X 16

,521

,000

/=

Man

agem

ent e

xpla

ined

th

at d

urin

g th

e pl

anni

ng

and

budg

etin

g pr

oces

s fo

r th

e FY

201

7/20

18

forg

ot to

inco

rpor

ate

the

outs

tand

ing

bala

nce

from

the

prev

ious

yea

r’s

outp

ut (p

urch

ase

of a

m

otor

veh

icle

) hen

ce

mak

ing

the

dive

rsio

n in

evita

ble.

0858

0: H

ospi

tal c

on-

stru

ctio

n/R

ehab

ilita

tion

Ren

ovat

ion

of

Mat

erni

ty w

ard

and

surg

ical

war

d to

im-

prov

e on

the

labo

r su

it an

d al

l oth

er

serv

ice

area

s on

the

two

war

ds

350,

000

350,

000

350,

000

323,

610

Non

eFu

nds

wer

e in

stea

d us

ed to

war

ds s

taff

ca

ntee

n co

nstr

uc-

tion

and

orth

oped

ic

wor

ksho

p. B

y th

e tim

e of

aud

it no

ne o

f the

st

ruct

ures

had

bee

n co

mpl

eted

. Th

e co

ntra

ctor

was

pa

id 1

00%

(198

,345

,610

) in

clud

ing

rete

ntio

n of

th

e co

ntra

ct s

um fo

r co

nstr

uctio

n of

the

staf

f can

teen

bef

ore

doin

g an

y w

orks

co

ntra

ry to

the

spec

ial

cond

ition

s of

the

cont

ract

(GCC

35.

1).

For

the

cons

truc

tion

of th

e O

rtho

pedi

c st

ruct

ure,

wor

ks w

ere

ongo

ing

and

was

at

roofi

ng b

y th

e tim

e of

au

dit i

nspe

ctio

n.

Of t

he fu

nds

rele

ased

, U

GX

26,3

90,0

00

rem

aine

d un

spen

t and

w

as s

wep

t bac

k to

th

e co

nsol

idat

ed fu

nd

at th

e en

d of

the

FY

2017

/18.

The

vari

ance

was

be

caus

e th

e Ea

st A

fric

a P

ublic

Hea

lth

Labo

ra-

tory

Net

wor

king

Pro

ject

(E

AP

HLN

P) s

uppo

rted

th

e ho

spita

l with

con

-st

ruct

ing

a la

bora

tory

at

the

site

whi

ch w

as

hous

ing

the

orth

oped

ic

wor

ksho

p an

d fo

r th

at

reas

on th

e ho

spita

l had

to

put

up

a st

ruct

ure

to

hous

e th

e or

thop

edic

w

orks

hop

and

prov

ide

a se

rvic

e.

-The

can

teen

was

co

nstr

ucte

d to

add

ress

th

e em

ergi

ng h

ygie

ne

issu

es a

roun

d th

e ho

spita

l sin

ce fo

od

vend

ors

had

turn

ed th

e ho

spita

l mai

n ro

ad in

to

a m

arke

t. Th

e va

rian

ce

betw

een

rele

ase

and

amou

nt s

pent

of U

GX

26,3

90,0

00 w

as b

ecau

se

it w

as s

wep

t bac

k to

the

cons

olid

ated

fund

at t

he

end

of th

e FY

.

0858

5: P

urch

ase

of

med

ical

Equ

ipm

ent

Pur

chas

e of

as-

sort

ed m

edic

al

equi

pmen

t inc

lud-

ing

mon

itors

for

high

dep

ende

nce

units

300,

000

300,

000

300,

000

300,

000

The

CT-S

can

an

d th

e X-

Ray

m

achi

nes

wer

e re

pair

ed a

nd

mai

ntai

ned

by

vari

ous

serv

ice

prov

ider

s

Ass

orte

d m

edi-

cal e

quip

men

t in

clud

ing

mon

i-to

rs fo

r hi

gh

depe

nden

ce

units

(Ste

riliz

-er

s an

d la

undr

y m

achi

nes)

not

pu

rcha

sed.

Emer

genc

e re

-pa

ir a

nd m

ain-

tena

nce

of th

e CT

-Sca

n m

achi

ne

and

the

X-R

ay

mac

hine

s

0858

1: S

taff

hou

ses

Cons

truc

tion

and

Reh

abili

tatio

n

16 u

nit s

taff

qua

r-te

rs c

ompl

etio

n 92

8,00

092

8,00

092

8,00

092

8,00

016

uni

t sta

ff

hous

e co

mpl

eted

Nil


Appendix VI: Showing details of funds diverted by Selected Health Sector Institutions

Description EFT / Check Number

Payment Date

Distribution Amount

Project Account

MINISTRY OF HEALTH

INSTITUTIONAL SUPPORT TO MOH (1027)

Monitoring and Evaluation

Facilitation for Project supervision for the construction of Regional hospital for Pediat-rics surgery in Entebbe.

18057792 13-Jun-18 4,800,000 1027 227001

Facilitation to carryout Stocktaking exercise of MOH Stores.

18368710 23-Jun-18 2,850,000 1027 227001


18369589 23-Jun-18 1,100,000 1027 227001


18369171 23-Jun-18 1,100,000 1027 227001


18369184 23-Jun-18 1,300,000 1027 227001


18368770 23-Jun-18 550,000 1027 227001


18369052 23-Jun-18 1,100,000 1027 227001


18369444 23-Jun-18 1,000,000 1027 227001


18369260 23-Jun-18 1,100,000 1027 227001

Capital development outputs

Technical support on the development of bills of quantities for staff canteen and records centre

15342947 19-Oct-17 10,052,000 1027 312101

Final payment for construction and equipping of Buyiga Health Centre III.

16316876 12-Jan-18 41,865,372 1027 312101

Construction of MOH motor vehicle service bay as per Interim certificate No. 1.

17326732 16-Apr-18 67,116,360 1027 312101

Payment for Construction of Staff houses in Kapchorwa, Certificate No. 1

17301452 03-Apr-18 31,449,384 1027 312101

Payment for Construction of Staff houses in Kapchorwa, Certificate No. 1

17301452 03-Apr-18 174,718,800 1027 312101

Construction of MOH motor vehicle service bay as per Interim certificate No. 1.

17326732 16-Apr-18 12,080,945 1027 312101

Certificate 13 Payment for construction of specialised hospital.

18385616 25-Jun-18 52,651,332 1027 312101

Construction of MOH service bay in respect of certificate No.2.

18368849 23-Jun-18 11,067,462 1027 312101


18385616 25-Jun-18 292,507,402 1027 312101

Interim Certificate No.1 for construction of MOH canteen.

18369434 23-Jun-18 8,601,197 1027 312101

Construction of MOH service bay in respect of certificate No.2.

18368849 23-Jun-18 61,485,900 1027 312101

Interim Certificate No.1 for construction of MOH canteen.

18369434 23-Jun-18 47,784,430 1027 312101

Repair works for MOH headquarters and cen-tral medical equipment

16305634 05-Jan-18 247,907,823 1027 312101



Payment Date

Distribution Amount

Project Account

Funds advanced for the relocation of main water pipes to allow construction of a can-teen.

17326718 16-Apr-18 3,540,000 1027 312101

Consultancy services for the construction of SMNHUP.

18369126 23-Jun-18 133,741,104 1027 312101


18385616 25-Jun-18 295,137,569 1027 312101

Consultancy services for the construction of SMNHUP.

18369126 23-Jun-18 24,073,399 1027 312101

Certificate 13 Payment for constructions of specialised hospital.

18385616 25-Jun-18 53,124,762 1027 312101

Renovation of KAYUP project offices at Wab-igalo.

18368779 23-Jun-18 33,413,600 1027 312101

Advance payment for renovation of Yumbe Hospital.

18392437 26-Jun-18 119,925,188 1027 312101


18392437 26-Jun-18 21,586,534 1027 312101

SUPPORT TO MULAGO HOSPITAL REHABIL-ITATION


Certificate 13 Payment for construction of specialized hospital.

18385616 25-Jun-18 81,042,226 1187 312101

Certificate 13 Payment for construction of specialized hospital.

18385616 25-Jun-18 450,234,589 1187 312101

REHABILITATION AND CONSTRUCTION OF GENERAL HOSPITALS


Facilitation for collection of EAPHLN data from various districts.

16040196 14-Dec-17 1,210,000 1243 227001


16040123 14-Dec-17 605,000 1243 227001


16040077 14-Dec-17 1,810,000 1243 227001

Facilitation for NGO inspection in Eastern and Northern Uganda.

16039978 14-Dec-17 1,560,000 1243 227001


16040065 14-Dec-17 2,415,000 1243 227001

Facilitation for NGO inspection in Eastern and Northern Uganda.

16040060 14-Dec-17 3,168,000 1243 227001

Facilitation during collection of data for the EAPHLN.

16414368 23-Jan-18 1,210,000 1243 227001


16414597 23-Jan-18 605,000 1243 227001


16414663 23-Jan-18 605,000 1243 227001


16414312 23-Jan-18 1,920,000 1243 227001


16414700 23-Jan-18 2,030,000 1243 227001


16414634 23-Jan-18 1,210,000 1243 227001



Payment Date

Distribution Amount

Project Account


Advance payment for renovation of Yumbe Hospital (LPO No.2)

18392437 26-Jun-18 228,813,559 1243 312101

Advance payment for renovation of Yumbe Hospital (LPO No.2)

18392437 26-Jun-18 41,186,441 1243 312101

CONSTRUCTION OF SPECIALISED NEONATAL AND MATERNAL UNIT IN MULAGO HOSPITAL



18392437 26-Jun-18 55,291,152 1315 312101


18392437 26-Jun-18 9,952,407 1315 312101

RENOVATION AND EQUIPPING OF KAYUNGA YUMBE GENERAL HOSPITALS

Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.

17992433 30-May-18 960,000 1344 227001

Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.(Driver)

17992379 30-May-18 440,000 1344 227001


17992390 30-May-18 960,000 1344 227001

Facilitation for Integrated support supervi-sion across RRHs, districts, general hospi-tals and HC IVs for Kasajja A(440,000) and Dr.Wamasebu G(1,040,000).

17992532 30-May-18 1,480,000 1344 227001


17992401 30-May-18 1,843,571 1344 227001

Facilitation for integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.(Driver)

17992385 30-May-18 440,000 1344 227001

Facilitation for integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs for Dr Idi Frankline A

17992428 30-May-18 1,040,000 1344 227001

Facilitation for integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.(Driver 440,000 and Amumpe J 1,878,657)

17992512 30-May-18 2,318,657 1344 227001

Facilitation for integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.

17992449 30-May-18 880,000 1344 227001


17992444 30-May-18 1,800,000 1344 227001


17992405 30-May-18 880,000 1344 227001


17992412 30-May-18 440,000 1344 227001


17992448 30-May-18 880,000 1344 227001



Payment Date

Distribution Amount

Project Account

Facilitation for Intergrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.(Driver 440,000 and Barigye C. 1,200,000))

17992516 30-May-18 1,640,000 1344 227001

Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs for Dr Ogwang Alfred Francis.

17992452 30-May-18 1,200,000 1344 227001


17992461 30-May-18 1,040,000 1344 227001

Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs for Tummushabe Joshua.

17992387 30-May-18 440,000 1344 227001


17992392 30-May-18 960,000 1344 227001


17992466 30-May-18 440,000 1344 227001


17992413 30-May-18 880,000 1344 227001


17992518 30-May-18 880,000 1344 227001


17992385 30-May-18 1,891,429 1344 227001


17992378 30-May-18 880,000 1344 227001


17992380 30-May-18 2,275,000 1344 227001


17992398 30-May-18 880,000 1344 227001

Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs for Bagwowabo Edward.

17992402 30-May-18 440,000 1344 227001


17992414 30-May-18 2,043,571 1344 227001


17992498 30-May-18 2,040,000 1344 227001


17992401 30-May-18 440,000 1344 227001

Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs for Luyige Coleb.

17992513 30-May-18 440,000 1344 227001


17992505 30-May-18 880,000 1344 227001



Payment Date

Distribution Amount

Project Account

Facilitation for Intergrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.(Driver 440,000 and Sebutinde. 1,040,000))

17992442 30-May-18 1,480,000 1344 227001


17992465 30-May-18 1,040,000 1344 227001


17992429 30-May-18 2,195,000 1344 227001

Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs for Baku Agnes.

17992389 30-May-18 880,000 1344 227001


17992396 30-May-18 1,971,429 1344 227001


17992464 30-May-18 880,000 1344 227001


17992524 30-May-18 440,000 1344 227001


17992386 30-May-18 880,000 1344 227001


17992444 30-May-18 440,000 1344 227001


17992415 30-May-18 960,000 1344 227001

Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs for Nkalubo Mary.

17992388 30-May-18 880,000 1344 227001


17992521 30-May-18 440,000 1344 227001

REGIONAL HOSPITAL FOR PAEDIATRIC SUR-GERY


17992431 30-May-18 880,000 1394 227001

Advance for Stationery, Folders, writing pads, and photocopying reports during integrated support supervision

17992516 30-May-18 1,400,000 1394 227001


17992406 30-May-18 960,000 1394 227001


17992435 30-May-18 960,000 1394 227001


17992460 30-May-18 2,188,657 1394 227001



Payment Date

Distribution Amount

Project Account


17992399 30-May-18 2,088,571 1394 227001


17992440 30-May-18 440,000 1394 227001


17992423 30-May-18 960,000 1394 227001


17992388 30-May-18 1,632,314 1394 227001


17992441 30-May-18 1,932,200 1394 227001


17992439 30-May-18 880,000 1394 227001


17992452 30-May-18 2,102,929 1394 227001


17992473 30-May-18 440,000 1394 227001


17992504 30-May-18 1,120,000 1394 227001


17992426 30-May-18 880,000 1394 227001


17992382 30-May-18 440,000 1394 227001


17992384 30-May-18 1,040,000 1394 227001


17992507 30-May-18 880,000 1394 227001


17992527 30-May-18 880,000 1394 227001


17992526 30-May-18 440,000 1394 227001


17992424 30-May-18 960,000 1394 227001


17992446 30-May-18 440,000 1394 227001


17992516 30-May-18 1,824,000 1394 227001



Payment Date

Distribution Amount

Project Account


17992445 30-May-18 2,226,600 1394 227001


17992509 30-May-18 440,000 1394 227001


17992408 30-May-18 880,000 1394 227001


17992409 30-May-18 440,000 1394 227001


17992454 30-May-18 960,000 1394 227001


17992457 30-May-18 1,824,000 1394 227001


17992438 30-May-18 440,000 1394 227001


17992419 30-May-18 880,000 1394 227001


17992436 30-May-18 960,000 1394 227001


17992418 30-May-18 880,000 1394 227001


17992530 30-May-18 880,000 1394 227001


17992391 30-May-18 880,000 1394 227001


17992532 30-May-18 2,125,857 1394 227001


17992519 30-May-18 440,000 1394 227001


17992381 30-May-18 440,000 1394 227001


17992462 30-May-18 1,200,000 1394 227001


17992395 30-May-18 880,000 1394 227001


17992467 30-May-18 960,000 1394 227001



Payment Date

Distribution Amount

Project Account


17992517 30-May-18 880,000 1394 227001


17992506 30-May-18 880,000 1394 227001


17992447 30-May-18 880,000 1394 227001


17992511 30-May-18 1,958,657 1394 227001


17992529 30-May-18 880,000 1394 227001


17992453 30-May-18 2,140,000 1394 227001


17992432 30-May-18 440,000 1394 227001


17992410 30-May-18 440,000 1394 227001


17992407 30-May-18 880,000 1394 227001


17992421 30-May-18 440,000 1394 227001


17992442 30-May-18 2,013,429 1394 227001


17992416 30-May-18 2,162,657 1394 227001


17992403 30-May-18 1,772,200 1394 227001


17992434 30-May-18 960,000 1394 227001


17992510 30-May-18 2,281,286 1394 227001


17992387 30-May-18 1,962,314 1394 227001


17992430 30-May-18 880,000 1394 227001


17992459 30-May-18 960,000 1394 227001



Payment Date

Distribution Amount

Project Account


17992501 30-May-18 2,140,000 1394 227001


17992428 30-May-18 2,386,000 1394 227001


17992508 30-May-18 800,000 1394 227001


17992397 30-May-18 2,175,743 1394 227001


17992450 30-May-18 880,000 1394 227001


17992427 30-May-18 880,000 1394 227001


17992755 30-May-18 880,000 1394 227001


17992515 30-May-18 880,000 1394 227001


17992389 30-May-18 1,928,571 1394 227001


17992400 30-May-18 880,000 1394 227001


17992417 30-May-18 440,000 1394 227001


17992458 30-May-18 880,000 1394 227001


17992528 30-May-18 880,000 1394 227001


17992383 30-May-18 960,000 1394 227001


17992394 30-May-18 880,000 1394 227001


17992523 30-May-18 440,000 1394 227001


17992503 30-May-18 2,017,857 1394 227001


17992443 30-May-18 880,000 1394 227001



Payment Date

Distribution Amount

Project Account


17992525 30-May-18 440,000 1394 227001


17992451 30-May-18 880,000 1394 227001


17992422 30-May-18 880,000 1394 227001


17992425 30-May-18 960,000 1394 227001


17992402 30-May-18 1,965,857 1394 227001


17992502 30-May-18 800,000 1394 227001


17992437 30-May-18 440,000 1394 227001


17992456 30-May-18 2,175,743 1394 227001


17992520 30-May-18 2,342,929 1394 227001


18057804 13-Jun-18 880,000 1394 227001


18131722 18-Jun-18 700,000 1394 227001


Settlement of advance payment certificates for the rehabilitation and expansion of Kayun-ga Hospitals.

18369373 23-Jun-18 190,541,594 1394 312101

Settlement of advance payment certificates for the rehabilitation and expansion of Kayun-ga Hospitals.

18369373 23-Jun-18 1,249,106,003 1394 312101


18392437 26-Jun-18 145,187,050 1394 312101


18392437 26-Jun-18 806,594,720 1394 312101

Procurement of medical furniture (Under URMCHIP)

8,135,630,000

MULAGO HOSPITAL COMPLEX

Final payment for Imaging and Nuclear med-icine equipment

23-May-18 3,306,937,218

Payment for supply and installation of equip-ment-China Sinopharm Int.Corp.

11-Jun-18 46,866,085

Procurement of aCT scan 11-Jun-18 191,220,000

Other structures-part payment on installa-tion of oxygen plant

26-Sep-17 350,000,000



Payment Date

Distribution Amount

Project Account

Other structures-Supply of imaging &nuclear medicine equipment

26-Oct-17 9,636,724,729

Other structures-Construction of 100 units of staff houses

30-Oct-17 671,631,200

UGANDA BLOOD TRANSFUSION SERVICES

SDA, perdiem & fuel in Masaka 14982945 13-Sep-17 651,000

Funds required to facilitate budgeting system training for 19th - 21st July 2017

14669113 17-Aug-17 692,000

Fuel, Lubricants and oils for UBTS HQtrs. 14669109 17-Aug-17 2,131,250

Mini Camp perdiem at Mubende Hospital 5th - 8th June,2017

14601012 09-Aug-17 151,000


14601005 09-Aug-17 151,000

Accountable advance required to facilitate re-view UBTS’s testing Algorthim workshop

14788669 24-Aug-17 1,200,000


14601006 09-Aug-17 232,000


14601002 09-Aug-17 151,000


14600999 09-Aug-17 151,000

Mini Camp perdiem at Mubende for Nassoro Erinah & Auma Eunice

14601011 09-Aug-17 362,000


14601004 09-Aug-17 151,000

Baggage allowance for Mr. Ntibatekereza Charles (Askari)

14600998 09-Aug-17 2,700,000


14601011 09-Aug-17 232,000


14601000 09-Aug-17 151,000

Accountable advance for Blood Publicity and donation for the first week of August 2017

14472571 01-Aug-17 9,250,000

Allowance for currying out board of survey exercise for FY2016/17

14964651 06-Sep-17 1,831,000


14601013 09-Aug-17 121,000


14600996 09-Aug-17 121,000

Funds for Qtr.ii activities 15379615 24-Oct-17 4,880,000

Advance for mobilisation work for 2nd quar-ter for FY 2017/18 for Karugaba Richard

15379471 24-Oct-17 200,000

Advance for mobilisation work for 2nd quar-ter for FY 2017/18

15379413 24-Oct-17 200,000

Allowance to be recovered from her monthly SDA

15468566 26-Oct-17 500,000

Accountable advance required to facilitate blood donation drive during the month of oc-tober 2017

15522977 30-Oct-17 9,868,500

Advance for mobilisation work for 2nd quar-ter for FY 2017/18

15379419 24-Oct-17 200,000



Payment Date

Distribution Amount

Project Account

Funds required to facilitate internal auditor’s activities in Rukungiri Blood Collection Centre

15252056 02-Oct-17 330,000

Fuel pre-payment for UBTS headquarters for qtr.II

15379472 24-Oct-17 2,131,250

Advance for SDA to settle emergency home problem

16340206 18-Jan-18 500,000

Additional Regional Blood Bank activities(1) 16993458 12-Mar-18 6,480,000

Accountable advance required to enable a team host Nakasongola blood donor club at UBTS H/QTRS and their Major activities will be to tour the bank, learn more about blood donation activities, Donate Blood, and will UBTS’s Ambassadors

16775931 21-Feb-18 6,000,000

GULU RRH

Supply of Generator 15642048 13-Nov-17 48,500,000 85681 312102

Supply of Generator 15638157 10-Nov-17 50,000,000 85681 312102

Demolition of Structures 15638160 10-Nov-17 48,000,000 85681 312102

MBALE RRH

Payment for Repairs& Servicing Hospital Vehicles.

18390265 26-Jun-18 23,928,543 85683 312202

Payment for Construction of Perimeter wall fence at the Hospital.

18361486 22-Jun-18 46,836,680 85683 312104

Payment for Minor works. 17611279 03-May-18 1,200,000 85683 312104

Payment for Construction of perimeter wall at the Hospital land.

18361486 22-Jun-18 47,754,600 85683 312104

FORT PORTAL

Supply of bookshelves 18069887 14-Jun-18 37,200,000 85672 312104

Construction of storeyed staff houses certifi-cate no. 3 part payment.

17992316 30-May-18 12,000,000 85681 281503

Construction of storeyed staff houses certifi-cate no. 3 part payment.

17992316 30-May-18 7,500,000 85681 281503

Part payment on certificate no. 2 on the con-struction of 16 units of storeyed staff houses

16541045 29-Jan-18 2,500,000 85681 281503

MBARARA RRH

Pay for repair of CT scan - Lot 2 17019938 16-Mar-18 35,112,670 85680 312101

Pay for supply of materials and repair of CCTV cameras

18287374 20-Jun-18 3,653,000 85680 312101

Pay for supply Counter Desk for Registry office

16239836 18-Dec-17 1,708,640 85680 312101

Pay for repair of Patient trolleys 18035514 08-Jun-18 3,728,800 85680 312101

Pay for supply of sundry equipment for Secu-rity Dept.

18003757 01-Jun-18 60,000 85680 312101


18003757 01-Jun-18 336,000 85680 312101

Pay for supply of materials to repair CT scan 18287400 20-Jun-18 1,042,000 85680 312101

Pay for supply of office Desk and chairs 17602516 02-May-18 290,000 85680 312101

Pay for supply of office Desk and chairs 17602516 02-May-18 700,000 85680 312101



Payment Date

Distribution Amount

Project Account


18003757 01-Jun-18 120,000 85680 312101

supply of metallic shelves 15288569 06-Oct-17 8,121,310 85680 312101


18003757 01-Jun-18 300,000 85680 312101

Supply and installation of Control Panel for X-ray

16239651 18-Dec-17 24,143,140 85685 312212

Pay for Lot 1 for supply of CT scan tube and maintenance services

17327329 16-Apr-18 245,156,860 85685 312212

Payment of cert. No. 2 for construction of staff canteen

18287412 20-Jun-18 64,259,437 85680 312101

Pay for Interim Cert. No. 1 for construction of staff canteen

18287412 20-Jun-18 134,086,173 85680 312101

Pay for repair of CT scan - Lot 2 17019938 16-Mar-18 35,112,670 85680 312101

MASAKA RRH

2PART PAYMENT ON INTERIM CERTIFICATE NO.3 FOR CONSTRUCTION OF THE SENIOR STAFF HOSTEL.

16287347 21-Dec-17 34,500,000 85682 312101

CONSTRUCTION WORKS DONE ON THE SE-NIOR STAFF HOSTEL [FINAL PAYMENT IN RESPECT OF INTERIM CERTIFICATE NO.3 INV. NO.1033 OF 13/11/2017].

16991750 9-Mar-18 218,938,294 85682 312101

EXTENSION OF GENERATOR POWER TO ALL WARDS AND UNITS AS PER INV. Nos 391,390,386,387, & 388.

18323987 21-Jun-18 25,139,620 85681 281504

TOTAL 28,734,212,001

Appendix VII: Showing duration of the procurement process

Procurement Subject Reference Code Date of initiation

Contract signing date

Average working

Days taken

Days delayed

MINISTRY OF HEALTH

Procurement of Assorted ICT equipment

MOH-URMCHIP/ SUPLS/2016-17/00006

05/10/2017 Not signed

Procurement of supply of 3 station wagon Lot 1

MOH-UHSSP/SUPLS/2016-17/00100/1

16/06/2017 16/02/2018 245 185

construction of staff houses for se-lected health facilities in Karamoja region

MOH KRSHP/WKRS/15-16/00003

10/09/2015 08/02/2016 151 91

Refurbishment and Equipping of Kawolo GH

MOH-SPSW/WRKS/2015-16/00001

30/05/2016 30/03/2017 304 244

The contract for Repartitioning and renovation of office space

MOH/WRKS/2016-2017/00631

10/04/2017 19/06/2017 70 10

The contract for Purchase of films vans for APC BCC interventions

MOH/SPLS/17-18/00209 20/03/2018 29/05/2018 70 10

Procurement of Electric Forklift MOH/SPLS/15-16/00830 13/10/2016 14/03/2017 152 92


MBARARA RRH

Construction of staff canteen MBRRH/WRKS/2017-2018/00087

5/02/2018 30/05/2018 83 23

Repair and maintenance of CT Scan

MBRRH/NCONS/17-18/00071

19/09/2017 9/01/2018 250 190

Supply of pioneer system console for the X-ray machine

MBRRH/SPLS/2017-2018/00036

7/09/2017 13/12/2017 109 49

Supply of a 30 seater Van MBRRH/SUPLS/17-18/00077

11/01/2018 14/07/2018 144 84

Construction of a 16 unit staff house

MBRRH/WRKS/2014-2015/00001

8/04/2014 4/01/2016 477 417

Construction of the Orthopedic Workshop

MBRRH/WRKS/17-13/00104

20/03/2018 30/05/2018 50 -9

MBALE RRH

Construction of an incinerator house and installation.

MBLRH/WRKS /16-17/00022

05/10/2016 16/05/2017 163 103

Construction of surgical complex building at Mbale regional referral Hospital

MBLRH/WRKS/2014-2015/00014

12/11/2014 05/08/2016 464 404

Supply of assorted office furniture MBLRH/SUP-PLS/2017-2018/00033

03/05/2018 Not yet signed by time of audit

Supply of assorted medical equip-ment

MBLRH/SUPLS/17-18/00018

21/02/2018 27/04/2018 47 -13

Supply of office furniture MBLRH/SUPLS/17-18/00018

21/02/2018 12/03/2018 19 -41

Appendix VIII: Showing inconsistencies in reporting among selected Health Sector Institutions

Programme /Project

Planned output Budget amount UGX (000)

Reported actual output Audit comment

MINISTRY OF HEALTH

Institutional sup-port to MoH

Output: 080272 Renovation of MoH 3rd Floor that was burnt.

1,384,042 Renovation of 3rd floor was com-pleted and handed over.

Amount spent UGX 1,384,042 on the output.

Only UGX 553,161,416 was spent on the planned output and UGX. 830,880,584 was diverted

Monitoring, Super-vision and evalu-ation

122,000 Annual transfer of funds to NMS, for uniforms and HMIS tools un-dertaken Health systems moni-tored, supervised and evaluated.

Amount spent UGX 121,800

A total of UGX 14,900 was diverted and therefore not expenditure under the Pro-gramme.

Support to Mu-lago hospital Rehabilitation

Hospital construc-tion / Rehabilita-tion

950,000 Construction of kawempe and Kiruddu at 99% completion

Procurement of medical furniture ongoing

Amount spent 855,000

A total of UGX 531,276 was diverted to completion of the specialized hospital


Italian support to HSSP and PRDP

Output: 080282 Construction of 68 staff houses in the Karamoja region

5,619,000 18 houses partially completed (75%)

Amount Spent 2,610,000

Overall percentage com-pletion according to the latest progress report was at 66.6% for all the 68 staff houses

All the UGX 5,619,000 was spent during the financial year 2017/18

Renovation and equipping of Kayunga and Yumbe general hospitals


204,330 Twelve site meetings held and contract implementation moni-tored

Amount spent UGX 204,330

Only UGX 157,791 was spent on the project, and UGX 46,538 was diverted

Output: 080280 Hospital construc-tion/ rehabilitation.

Renovation and Equipping of Kayunga and Yumbe

0 NO Gou funds Spent A total of UGX 2,470,887,773 from GoU was spent on the output, but it is not reported about.

Regional Hospi-tal for paediatric surgery


140,000 A few visits were made in the last quarter from Head office

Amount Spent UGX 139,988

Only UGX 40,000 was spent on the project, and UGX 99,988 was diverted.

Output: 080280 Hospital construc-tion/ rehabilitation

Regional hospital for paediatric sur-gery

800,000 95%

completion of Excavation and concrete works, Erection of Rammed earth wall and steel structure was at 60%, Completion of the detailed design for Me-chanical, Electrical and Plumbing systems 100%, Internal and Ex-ternal

finishes

Amount Spent 9,428,000,000

Only UGX 7,036,570,633 was spent on the output and UGX 2,391,429,367 was diverted to Kayunga Yumbe project.

GAVI Vaccines and Health Sec-tor Development Support

Preventive and curative Medical supplies

10,000,000 Procured:

881,580 of HPV doses;

1,914,600 of PCV doses

1,911,000 of Penta doses;

1,060,800 of Rota Virus doses and

1,713,600 of IPV doses

Amount spent UGX 4,696,110

A total of UGX 10,000,000 was spent on the procure-ment of vaccines.


Expenditure on Recurrent activ-ities

64,485,000 The released recurrent budget was UGX 59,047,000

According to the 4th Quarter performance report, the actual recurrent release was UGX 59,047,000 and as per the Integrated Financial Management Information System (IFMIS) BIG (Budget analysis) Report, the actual release was UGX 56,917,308. Management should explain the reasons for the varianc-es in the recurrent releases since the BIG Report and the 4th Quarter report should be in harmony.

UBTS

Capital develop-ment outputs

370,000,000 Total amount released on the capital development outputs UGX 150,000,000 and UGX 353,000,000 was spent.

Review of the Payment file and the BIG report from the IFMS system revealed that a total of UGX 356,000,000 was released for implementation of the capital development outputs out of which UGX 353,000,000 was spent

GULU RRH

Output: 81 Staff house construc-tion and rehabil-itation 312101: Construction of 54 unit staff House

312102: Demolition of old radiology building

UGX 1,338,000,000

UGX 50,000,000

• A total of UGX 1,338,000,000 was spent on the output by the year-end.

• There are no details on the activity apart from an expen-diture of UGX 50,000,000

•Review of the payment file indicates that only UGX 1,191,500,000 was spent on the output. And the bal-ance of UGX 146,500,000 was diverted.

•There were no details on the output indicated in the annual performance report. However a review of the payment file indi-cated that a total of UGX 48,000,000 was spent in respect of the output.

Output 77: Pur-chase of spe-cialised medical equipment

Assorted medical equipment includ-ing BP, and CBC machines

100,000,000 • An expenditure of UGX 98,700,000 under the spe-cialized machinery and Equipment without details on the out upon which the funds were spent.

• Review of the annual performance report re-vealed that there were no details about the output in the report apart from the expenditure of UGX 98,700,000


FORT PORTAL

Output: 085672 Government Buildings and Ad-ministrative infra-structure

312104 Other Structures

Government Build-ings and adminis-tration buildings

maintained includ-ing sanitation

39,572,000 Administration buildings main-tained, regular cleaning and sanitation services contracted. Infection prevention and control meetings in and outside the hos-pital and held. Actual spent was UGX 37,200,000.

Out of the budgeted UGX 39,572,000 for other struc-tures, UGX 37,200,000 was diverted to supply Book-shelves and paid to crown health care (U) Ltd. The re-ported actual outputs were never achieved as reported.

Output: 81 Staff houses construc-tion and rehabili-tation

Engineering and design works started. Monitoring and supervision of construction works. Staff hous-es constructed, re-habilitated, main-tained including

sanitation

882,428,000 Continuation of works of a 16-unit staff hostel. On-going monitoring and supervision of construction of works and actual spent was UGX 54,893,000

It was reported that UGX 12,000,000 was spent on Engineering and Design Studies & Plans for capital works, and UGX 7,500,000 spent on Monitoring, Super-vision & Appraisal of capital works. Audit noted that activities never took place since the funds earmarked for them were diverted and paid to the contractor. There was no single monitoring and evaluation report pro-duced to confirm that the activity took place.

It was reported that the actual amount spent for the output was UGX 54,893,000. Analysis of the payment file indicated that the actual ex-penditure on the output was UGX 860,428,343.

MASAKA RRH

Output: 81 Staff houses construc-tion and rehabili-tation

Construction of a 40 unit senior staff hostel

UGX 500,000,000

Foundation for all the 40 units’ staff hostel Completed. UGX 500,000,000 spent. Where UGX 30,000,000 was spent on Moni-toring, Supervision & Apprais-al of capital works and UGX 470,000,000 spent on Residential Buildings.

Review of the payment file indicated that the hospital spent UGX 728,298,674 which was over and above the budgeted amount by UGX 253,438,294 con-trary to the actual re-ported expenditure in the 4th quarter report of UGX500M.

Output: 82 Ma-ternity ward construction and rehabilitation

Construction of a maternity ward and children’s complex

1,558,000,000 Completing the construction of the superstructure of materni-ty and Children’s complex. Total reported expenditure was UGX 1,558,000,000.

Review of the work plans and payment files indicat-ed that whereas the hospi-tal budgeted to spend UGX 1,558,000,000 for construc-tion of a maternity ward and children’s complex, the hos-pital spent UGX 1,304,561,706 of the output and the balance of UGX 253,438,294 was di-verted.


MBALE RRH

Project 1478 Out-put 83: 83 OPD and other ward construction and Rehabilitation.

1. Procurement of Double cabin pickup truck

2. Purchase office equipment

3. Purchase of assorted medical equipment

4. Construction of a bigger incinera-tor, Renovation of acute care unit

UGX 200,428,543

UGX 130,000,000

UGX 227571,000

UGX 500,000,000

1. This output is not reported on in the annual performance report (Q4)



4. Incinerator constructed at 100% Fencing of hospital land at 5% completion.

1. A total of UGX 176,500,000 was spent on the output and the balance of UGX 23,928,543 diverted on repair of motor vehi-cles

2. A total of UGX 130,000,000 was spent on procurement of as-sorted office furniture.

3. The details of the out-put were not properly included/specified in the annual work plan

4. The renovations worth UGX 25,333,619 on the Acute care Units are not reported upon.

MBARARA RRH

Output: 80 Hospi-tal Construction/ Rehabilitation Renovation of maternity ward and surgical ward to improve on the labour suite.

UGX 350,000,000

1. Staff canteen construction BOQs already reviewed, contrac-tor procured and contract man-agement team appointed.

2. Funds already received, works started expected to be finished by August. Payments already made totaling to UGX 64,259,437 Million already received and paid to the contractor.

3. Works have been started to construct the Orthopedic struc-ture that is already at

roofing level to create room for the upcoming lab construction by the EAPHLN. The total cost is UGX 26,390,000 but the payment bounced

1. The works that were expected to be complete by August were not com-pleted by audit inspection time in September 2018. The report indicated that funds totaling to 64,259,437 was paid to the contract however, before 30th June 2018 funds amounting to 198,345,610 had been paid to the contractor before any work had been done contrary to the conditions of contract. The reported output has no relationship with the planned output as it was a diversion charged on the planned out-put code.

2. The reported construc-tion of the orthopedic work-shop has no relationship with the planned output as it was a diversion charged on the planned output code. It was also reported that the structure will be ready for handover in August 2018 but at audit inspection time in September, work was not complete and the site was abandoned.


Output 85: Pur-chase of medical equipment

Assorted medical equipment includ-ing monitors for high dependence units (Ventilators, laundry washing machine and ster-ilization equip-ment)

300,000,000 The process was initiated to pro-cure sterilization and laundry but the CT Scan machine and X-ray broke down and had to be re-paired.

2.The contractor to repair the CT Scan was sourced and the CT scan machine is functional

3.The contract for repairs and maintenance including the atten-dant parts for the CT scan ma-chine has already been

signed with M/S Pacific Diagnos-tics

Ltd.

4. The Service contract for ser-vicing the X-Ray machine was secured and the machine is func-tional.

The two equipment installments are functional and in use

1.In the 4th quarter report, the hospital indicated that it had spent a total of UGX 245,156,860 on repair and maintenance of the CT scan and the X-ray machine. However, payment records indicate that a total of UGX 323,099,860.33 was spent on repair and maintenance of the CT scan and the atten-dant parts including taxes, and a total of UGX 24,143,140 was spent on the servicing of the X-ray machine.

Overview of Vote expenditure

Gou Development

1.978 bn It was reported that by end of quarter four (4) UGX 1.978 bn had been released and UGX 1.872 bn spent representing 94.6% of the releases spent.

However, review of the pay-ment file indicated that the hospital had spent about 98% leaving 26,390,000 un-spent.

Audit House, Plot 2c ApolloKaggwa Road,P.O. Box 7083 Kampala,Tel: 041-7-336000,Fax: +256-41-435674,Email: [email protected],Website: www.oag.go.ug