Closing Remarks by Civil Society at 15th Ministry of Health, Joint Review Missions (JRM) November 26th 2009
The Hon. Minister of State for Hea,
Permanent Secretary, Ministry of Health
Director General of Health Services,
Officials from the Local Governments,
Members of Parliament,
Representatives from our Development Partners,
Representatives from CSOs,
Distinguished Guests,
Ladies and Gentleman,
Good Evening. My name is Sandra Kiapi, I work with Action Group for Health, Human Rights and HIV/AIDS (AGHA)-U, a health rights advocacy organisation based in Uganda. I speak on behalf of civil society organizations working in the health sector in Uganda. CSOs appreciate their involvement in the Joint Review Mission as well as the general planning, budgeting, implementation and monitoring process in the sector.
Over the past four days we have been reviewing progress, identifying problems, proposing solutions, and strategies to improve the performance of the health sector. There are indicators that we have scored some progress.
We commend the Government and our development partners for the increase in financing. Our per capita expenditure on health has increased from US $ 7.84 to 10.4. The Government of Uganda budget allocation to the health sector (excluding donor support) increased from Uganda shillings 242 billion in 2006/07 to 375.38 billion in FY 2008/2009. There has also been a consistent and steady annual increase in the financing of medicines. There have been efforts to revise the drug distribution mechanism in a bid to eliminate drug stock—outs.
There have been steps taken to mainstream human rights into the sector through a health and human rights desk. There are also efforts to promote the Paris Principles on Aid Effectiveness as well as the Accra Agenda for Action through the signing of the Global compact of International Health Partnerships (IHP+) as well as the implementation of the Joint Assessment Framework (JAF). We also have developed key policy documents like the Retention Strategy which is implemented can go a long way in achieving our goals.
However, year after year, we are still discussing some of the same problems-drug stock-outs, health worker shortages, inadequate financing and mismanagement of public resources. Our progress is very slow.
Currently, only 8.3% of the national budget is allocated to the health sector - way off target from the Health Sector Strategic Plan estimate of 13.2%. The per capita expenditure on health is a third of what is needed to achieve national and international health targets. Our minimum health package – the basic package of services that we believe all Ugandans should be able to access – is not fully funded, which leaves gaps in primary health care for many Ugandans. Levels of funding for EMHS are still at a record low of USD 0.93 compare to the projected costing of 5.86 per capita.
At the NHA, we still heard about serious audit queries in the use of funds within the sector. Weaknesses in the procurement process at the central MoH; doubtful delivery of drugs to Soroti, and overpayment of contractors to a tune of over 600 million -a figure which is greater than the PHC wage bill of at least 10 districts in Uganda. We need money for health, but we must also deliver more health for the money we have available. We must promote a policy of zero tolerance for mismanagement of our limited resources.
We learnt yesterday that the health system is the least staffed in the Local Governments. We are still challenged by the inadequate numbers of health professionals to meet the needs of our communities, as we lose health professionals to better salaries and improved working conditions outside of the public sector and sometimes even outside the country. Currently, the approved staffing levels are at an average of 56%. But some districts still lag behind at a level of 38%, and the percentage is much lower at Health Center II Level-22%. Even where funds available for recruitment, the sector has failed to attract staff. The WB and MFPED study revealed that the issue absenteeism has become chronic stands at 40%. Furthermore, poor leadership and management have been identified as factors inhibiting performance in the sector.
Many heath facilities still suffer from stock-outs of essential medicines, despite the considerable effort that the Government of Uganda and the Ministry of Health have put into improving drug procurement and distribution systems. Only 26% of sampled health units had continuous availability of all indicator medicines.
CS organizations make a great contribution to the sector through service delivery, advocacy, as well as monitoring performance. While there are formal structures for CS involvement in decision making at the MoH, at the districts, CS involvement remains weak and sometimes uncoordinated. CS is making efforts to improve this coordination, but this effort needs to be backed with strong proactive support from MOH, also to be reflected through DHO’s office and the local governance structures. The MoH should support the efforts of CSOs by building their capacity to participate in planning, budgeting, monitoring, fundraising for the sector.
We are hopeful that things can get better if we all commit ourselves to playing our roles in the rightful manner. Next year, we will roll into NHP II and HSSP III. It is an opportune time for change. The past four days have revealed a multiplicity of glaring issues which must be addressed. However, some issues must be emphasized.
(a) We MUST promote strong leadership, good management and governance practices in the sector. We need to identify the right people, with the right skills, qualifications, and right personal attributes-people with vision and inspirational qualities- to manage the sector; we need to move away from political appointments to transformative leadership. The MOH must take steps to improve the quality of leadership and management at all levels, and as a matter of urgency develop a strategy put an end to absenteeism.
(b) The sector needs additional resources to meet health needs and fill the financing gap. GoU, Development Partners, CSOs must partner to find ways of filling financing gaps especially for essential medicines and health supplies. A comprehensive, health financing strategy must be developed and additional innovative methods of financing such as SHI should be urgently looked into.
(c) The role of oversight structures at all levels-right from the Parliament, Boards of autonomous health instititutions, RRH, DDHS, as well as HUMC must be strengthened in order to provide oversight on the use of limited resources. In the context of EMHS, Parliament must provide close oversight and monitor the financial and operational performance of NMS.
(d) It is imperative that the GOU, MOH and partners devote sufficient priority and resources to address the HRH crisis as whole. Through a multistakeholder approach, we MUST make a deliberate effort address the issue of attracting and retaining health workers particularly in the hard to reach areas. Increasing health worker compensation and providing additional motivational benefits such as appropriate staff housing will provide health workers the incentive to accept positions particularly in underserved areas.
(e) We MUST promote collaboration between departments, sectors and all stakeholders. The PPPH policy must be finalized and operationalised so that the Public and Private and CSO can collaborate to improve the sector. In developing our new NHP, HSSP III, we must make the linkage between health and its underlying determinants including access to food, sanitation & clean water, and health related information.
(f) In the spirit of a Right Based Approach, we MUST promote access for more vulnerable and disadvantaged groups particularly PWD, people in under served regions like Karamoja as we develop and roll out the NHP II and HSSP III. We need greater emphasis on community participation in order to combat the disease burden at household level. This calls for strengthening and scaling up the existing structures such as VHTs.
(g) Timely, accurate and consistent quality data collection is critical at every level of the sector. Data must be compiled and analyzed regularly and used for planning and decision making.
(h) Future NHA/JRM should allocate time and space for all partners-especially CSOs to engage in more rigorous presentations and discussions.
Let us continue the cooperation between the public and private spheres. We know where we want to go, but we need to work with a renewed energy and with a stronger commitment to achieve progress at a faster pace.
Thank-you for listening to me.
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