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Despite more supplies, clinics still underperform, report says

Despite an increase in availability of essential medicines and other health supplies, performance of health facilities remains below targets set by the health sector strategic investment plan (HSSIP), a report has found.

The annual health sector performance report unveiled by the ministry of Health on October 20 during the 20th annual joint review mission, shows that the percentage of deliveries in health facilities is still unacceptably low. Although the percentage of women delivering in health facilities slightly increased to 44 per cent in 2013/14 from 41 per cent in 2012/13, the performance fell short of the 65 per cent HSSIP target.

The central region led with over 200,000 deliveries in health units while the western region recorded the lowest facility-based deliveries with only 185,729 deliveries in the financial year 2013/14. Moreover, the percentage of pregnant women attending at least four antenatal care sessions remained stagnant at 32 per cent.

“Despite improved efforts at recruitment and deployment, some of the health facilities do not have some key health workers such as anaesthetists and doctors. Distributional disparities still adversely affect the quality of reproductive health services,” Dr Jane Ruth Aceng, the director general of health services in the ministry of Health, said.

Also, the contraceptive prevalence rate of 30 per cent is still below the HSSIP target of 40 per cent. Other parameters that were used to measure the health sector performance include; in and out-patient attendance, functionalisation of health facilities, maternal, infant and neonatal death, human resource and immunization coverage.

The sector demonstrated good progress in immunization of children with 93 per cent of children below one year immunised with the third dose of the pentavalent vaccine, a combination of five vaccines in one that prevents diphtheria, tetanus, whooping cough, hepatitis B and influenza type B.

The report, however, notes that functionalisation of health centres IV (HC IV) remains a key challenge for the sector despite a significant increment in the compensation of doctors.

A HC IV is the first referral facility in areas without hospitals and their functionality is determined by service standards such as capability to do blood transfusions, maternity deliveries, antiretroviral therapy and long-term contraception and outpatient services.

“This may be linked to the challenge of not having matching improvement in compensation of other cadres of staff that is vital to the team production process at health centres,” the report partly reads.

Some of the best-performing HC IVs include Mpigi, Serere, Mukono CoU, Rukunyu and Nyahuka. The report also indicates that the number of posts filled by health workers has improved from 63 in 2012/13 to 69 per cent in 2013/14 owing to the mass recruitment drive.

Currently, 16, 574 posts in public facilities need to be filled. Of these, health centre IIs need over 7000, Mulago national referral hospital needs 581 and regional referral hospitals need 924 health cadres.

“We need to ensure that trained health workers are deployed and given enough incentives to stay. We should not expect them to be angels. Health workers have been turned into a punching bag. They are being blamed for everything that fails in the system yet some agencies ought to take responsibility,” said Prof Freddie Ssengooba, the chair of health policy and planning at Makerere University, in his keynote address.

Nwoya was the leading district in all parameters, followed by Gulu, Masaka, Lyantonde, Rukungiri and Kamwenge. The worst-performing districts were Amudat, Kaabong, Ntoroko, Moyo, Kween, Sembabule and Moroto.


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