4 fundamentals of health services management.ppt
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Fundamentals of Health Services
Management: Session 4
Organization of Health Services in
Uganda (Refer to HSSIP)
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National level organization of health
services in Uganda- i
The national health system is made up ofpublic and private sectors.
The public health system includes all facilities
of the MoH, MoE, MoD and Ministry of
internal affairs.
The private health system is made up of
PNFPs, PFP, TCMP (Traditional and
Complementary Medicine Practitioners)
The private health system provides about 50%
of standard Units of output
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National level organization of health
services in Uganda- ii The health services are decentralized following
the political system.
At the national level, the system has the MoHand the National Referral Hospitals (Mulago and
Butabika)
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National level organisation of the health
services in Uganda -iii
According to the HSSIP, the core functions of the
MoH are:
Policy analysis, formulation and dialogue;
Strategic planning;
Setting standards and quality assurance;
Resource mobilization;
Advising other ministries, departments and
agencies on health-related matters;
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Core functions of MoH
Capacity development and technical supportsupervision;
Provision of nationally coordinated services
including health emergency preparedness andresponse
and epidemic prevention and control;
Coordination of health research; and
Monitoring and evaluation of the overallhealth sector performance.
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Uganda national health services
organisation National referral hospitals
provide comprehensive specialist services and
are involved in health research and teaching in
addition to providing services offered by
general hospitals and Regional Referral
Hospitals.
There are so far only two national referral
hospitals- Mulago and Butabika- (Mbarara isbeing prepared to become the 3rd The
conversion is said to be about complete)
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National Health Facilities are generally
not sufficient!! (Source:MoH HSSIP)
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Uganda National health services
organisation- Regional referral hospitals
Offer specialist clinical services such aspsychiatry, Ear, Nose and Throat (ENT),ophthalmology, higher level surgical and medical
services, and clinical support services (laboratory,medical imaging and pathology).
These hospitals serve a region
They are also involved in teaching and research.This is in addition to services provided by generalhospitals.
Regional referral hospitals report to the centre
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List of 12 RRHs
1.Arua Regional Referral
Hospital
2.Fort Portal Regional Referral
Hospital
3.Gulu Regional Referral
Hospital
4.Hoima Regional Referral
Hospital
5.Jinja Regional Referral
Hospital
6.Kabale Regional Referral
Hospital
7.Lira Regional Referral
Hospital
8.Masaka Regional Referral
Hospital
9.Mbale Regional Referral
Hospital
10.Soroti Regional Referral
Hospital
11.Moroto Regional Referral
Hospital
12.Mubende Regional Referral
Hospital
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Private Not For Profit (PNFPs)
These are health facilities founded by faith based
organisations.
PNFPs provided the first organized health services to
Africans in Uganda- beginning at Mengo in 1897 by A R
Cook.
The PNFPs belong to three main net worksnamely the
UMMB, UCMB and UPMB. There are other bureaux
including the Orthodox Medical Bureau.
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PNFPs contribution to health services (NHP, 2009)
The FBPNFPs account for 41% of the hospitals
and 22% of the lower level facilities and are
more present in rural areas, thereby
complimenting government facilities.
The PNFPs operate 70% of health traininginstitutions with financial support from GoU
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PNFPs
This ratio of PNFPs to government facilities is
changing because government is converting
many HC-IV to district hospitals.
However, PNFPs are said to be more efficient
than public health facilities- and are said to be
more productive.
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Ownership and organisation of PNFPs -i
PNFP health facilities belong either to the Anglican,
Pentecostal, SDA, Catholic or Muslim faiths.
Majority of PNFP health facilities belong to the Anglican or
Catholic faith and are organized under the UPMB or UCMB.
UCMB and UPMB as well other bureau, are umbrella
organizations and just coordinate and empower the activities
of the facilities
Facilities belong to local congregations or dioceses
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Ownership and organisation of PNFPs-ii
PNFPs are better structured and more organizedthan other private health services.
They also have better collaboration among themselves and with government.
As noted earlier , private health services provideup to 50% of standard units of out BUT have notas much integration with national health systemas there should be for maximum outputs/benefit
In this regard, a public private partnership forhealth(PPPH) is being worked on
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Ownership and organisation of
PNFPs -ii The PNFPs are guided by government policies
At district level, PNFPs report to DHOs but
they also report to diocesan health
coordinators and health boards.
PNFPs do not compete with public health
facilities but rather suppliment government
effort and about 20% of their budget, is metby government grants
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PNFP Hospitals
PNFP Hospitals are classified as general
hospitals although many may qualify to be
regional referral hospitals. Some of these, like
Nsambya, are now teaching hospitals and theyoffer specialized services
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PFP Health facilities There are approximately 14 private individuals
owned by individuals or institutions.
These provide services with the objective of making
a profit. They are mainly in towns where users can
pay.
They are also treated as general hospitals althoughsome of them like Kampala International receive
referrals from other hospitals and are also teaching
facilities
According to NHP (2009), these PFP are largely
unregulated and have little collaboration with
government
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Traditional & Complementary Medicine
Practitioners(TCMP)
Mostly not regulated BUT up to 60% ofUgandan are said to use their services before
visiting formal sector (NHP, 2009)
They have little or even no functionalrelationship with private or public health
services providers
A legal framework for their functionality is
awaiting implementation but has been
developed
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District Health Services
During decentralisation, districts were charged with the
responsibility of service delivery at district and health sub-
district (HSD) level
District health services are managed by ministry of local
government
The district health team (DHT) chaired by the DistrictHealth Officer provides technical leadership for the health
care services at the district level
At the health sub district, a medical officer assists the DHO
in managing the health care services. District Health Teams and HSDs supervise service delivery
at government and PNFP facilities at different levels,
except the national and regional referral hospitals.
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Structure of health services at district
level-i
The lowest level of the health care system in
Uganda is the household/community or village.
In the community/village, there is a Village
Health Team (VHT) whose role is to link health
facilities with the community (HSSP III).
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Structure of health services at
district level-ii
The first level of interaction between the
formal health sector and communities is HCII
where only out-patients services are
available.
HCIII provide maternity services and the first
referral cover for the sub-counties (HSSPIII).
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Structure of health services at
district level-iii
Next to HCIII, are health sub-districts and
according to the HSSPIII, P.4: The health sub-
district is mandated with planning,
organization, budgeting and management ofthe health services at this and lower health
center levels. At the districts, it is the
responsibility of local government to plan forand provide health services as stated by the
HSSPIII, p.4.
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Comparing Core Functions of Central
Government and District Local Governments
Central Government Core Functions Policy formulation
Setting standards
Quality assurance
Resource mobilisation
Capacity development
Technical support
Provision of nationally coordinated
services e.g. epidemic control
Coordination of health research
Monitoring and evaluation of overall
sector performance
District Local Government Core Functions
Implementation of the national health policy
Planning and management of district health
services
Provision of disease prevention, health
promotion, curative and rehabilitative services
with emphasis on the minimum health carepackage and other national priorities within
the district
Control of other communicable diseases of
public health importance
Vector control
Health education Ensuring provision of safe water and sanitation
Health data collection, management,
interpretation, dissemination and utilisation
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