Mbonye said that they shall set targets. Facilities and workers who won’t meet the targets won’t receive any of this money (for results-based financing).
PIC: Minister of Health, Dr. Ruth Jane Aceng during the 22nd Health Sector Joint Review Mission workshop at Imperial Royale Hotel on September 29, 2016. Photos by Mary Kansiime
The scapegoat has largely been remuneration. Health workers earn peanuts and should therefore be forgiven when once in a while they absent themselves from duty or show-up but leave three hours later. They won’t have the excuse this time. Other excuses, yes; but not of poor pay.
The health ministry – which takes care of the workers – is fronting a strategy, and once Cabinet approves it and Parliament puts its seal, health facilities and workers in the country will get financed according to their output. The hardworking health units, which will meet and exceed their targets, will get additional funding commensurate to their 'exceptional’ work.
The move is aimed at motivating health workers and improving service delivery in the sector.
Prof. Anthony Mbonye
The acting director general of health services Prof. Anthony Mbonye said the World Bank had already approved $140m (sh469b) for the results-based financing strategy. ($110m of the money is a loan. $30m is a grant). But part of the money will also be used to purchase essential medical supplies to improve the number of mothers who are delivered at health facilities and the quality of care at birth.
The new funding strategy, which is opposed to the routine input-based financing the ministry currently implements, is expected to commence beginning the 2017/2018 financial year.
Mbonye said that they shall set targets. Facilities and workers who won’t meet the targets won’t receive any of this money (for results-based financing). They will keep with their baseline financing.
“We shall set targets. For instance, put deliverers at health facilities at 85%, immunization at 95%, family planning at 80%. We shall have general performance targets for all of our health units,” Mbonye said on the sidelines of the sector review meeting at Imperial Royale Hotel in Kampala on Thursday.
“Health facilities are supposed to hold meetings, requisition for drugs and other supplies, staff is supposed to be in uniform, and they should frequently feed in their (hospital) data into our HMIS (health management information systems).”
“We shall track and assess their performance. The health units which will excel will get additional money that can be distributed among the facility staff or to buy them other incentives to keep the morale high,” Mbonye said.
Health minister Dr. Jane Ruth Aceng said they planned to introduce performance-based financing to motivate facilities and workers who were exceptional and doing quality work to improve health care in Uganda.
But the Uganda Network of Aids Service Organizations executive director Joshua Wamboga called for strengthening of health systems and management at facilities to improve quality of services.
The joint sector review meeting, themed around new health reforms and reproductive health, highlighted that the country had reduced its newborn deaths to 22 per 1,000 live births in 2015, from 33 per 1000 live births in 2001. Infant mortality stands at 44 per 1,000 live births, compared to 85 per 1,000 in 1995; while under-five mortality stands at 66 per 1,000 live births compared to 152 per 1000 live births 20 years ago.
Aceng said the government gave free ARVs to about 800, 000 today and reiterated that they needed to consolidate the gains in the fight against HIV.
“Over the last financial year more than 1,000 generally healthy women succumbed to maternal deaths. We can’t allow this and should work towards changing it, making it better,” she said.
She said that they planned to construct 255 health centre IIIs at sub-counties which still didn’t have health facilities in the next five years.
The ministry also plans to upgrade additional 89 health centre IIs across the country to health centre IIIs.
The 2015/2016 ministry of health sector performance report shows that over 62% of health centre IVs in the country can now handle caesarian sections to expectant mothers. This figure needs to be improved.
The report mentioned Mbale, Mbarara, and Gulu among the best performing regional referral hospitals, while Kabale ranked lowest.