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Catalyzing service delivery in health in the twenty focus districts

In line with its mandate to fast track implementation of executive priorities anchored in the NDP II, PMDU employed a deliverology methodology in collaboration with MDAs to achieve rapid results in key government priority programs. Deliverology nurtures a culture of speed, rigor and visibility of results in public service delivery, using a combination of practices consisting of Delivery Labs; Stock-takes; real-time Data Delivery Chains within a framework of multi-level and inter-agency stakeholder engagements. 

Guided by the 5 Principles of deliverology namely Prioritization, Planning for delivery, Problem solving, Pressure for results and Progress reporting, PMDU Health thematic area working closely with thematic areas has for the past 5 years, piloted the delivery methodology in 20 pilot districts in Eastern Uganda namely Mbale, Kween, Kayunga, Sironko, Soroti, Namutumba, Bukwo, Bulambuli, Serere, Pallisa, Luuka, Kapchorwa, Buyende, Bududa, Buvuma, Kaliro,Bugiri, Manafa, Mayuge.

PMDU’s choice was informed by poor PLE Performance; the need to consolidate efforts and resources, as opposed to scattering by the three (3) PMDU service delivery thematic areas namely education, infrastructure and Health was prioritized.

Over the years, and working closely with other thematic areas, Health has successfully undertaken the following delivery actions and released a number of successes:

  1. Engagements with Political and Technical Sector-specific leaders at Central level and in the 20 local governments with a focus on Priority setting and gaining consensus on Sector specific outcomes specifically improving health workforce productivity through increased worker attendance to duty which is foundational to improving quality of health.
  2. Established an Inter-ministerial task force for Health, comprised of technical representatives from the sectors of Health, Education, Local Government and Public service and, other stakeholders. This has pprovided a mechanism for coordinating implementation efforts across government and enabled better inter-ministerial coordination while ensuring clear delineation of responsibilities and accountability throughout implementation stages. Through the monthly inter-ministerial taskforce meetings, technical issues related to implementation are discussed and escalated appropriately within the respective sector hierarchies and progress with attendance is closely monitored.
    Health Inter-ministerial Task Force Meeting

The head PMDU with the Health Inter-Ministerial force after a successful meeting that focused on unlocking the bottlenecks to accessing real-time attendance data.

  1. Instituted and are implementing a rigorous system for tracking routines and appraising progress on agreed results and targets. At central level, routine engagements with Sector leaders (stock-takes) to review progress and resolve implementation bottlenecks has been institutionalized.


Below: Former Rt. Hon. PM with Top leadership of the collaborating sectors following a successful sector stock take

  1. At Local government level, the Rt. Hon. Prime Minister convenes regional stock-takes bi-annually, during which political and technical leaders of the respective pilot districts come together to celebrate successes, learn from each other,  share best practices, discuss implementation bottlenecks and, jointly agree on actionable solutions. This forum has provided an opportunity for district local governments to give accountability guided by attendance data for teachers and health workers, on the various actions taken against absentee staff as well as innovations for motivating good attendance.

Biannual Stakeholders engagements with political and technical leaders of government (LGs)

Former Rt. Hon. PM with district leaders (LC, Vs, RDCs, CAOs, DHOs, DEOs) and other district leaders at the Civil Service Collage Jinja, after a three day stock take on progress with attendance tracking.

Tororo and Kaliro District leaders receiving a certificate from the Rt. Hon PM.

This has not only strengthened accountability but also improved returns on investment as a number of districts have reported having taken measures such as deletion of absentee staff from the payroll, suspensions and dismissals and Pro-lata payments


Sample warning letters issued to absentee staff by DLGs

Technical thematic area staff visit randomly selected health facilities without prior notification and perform spot checks on attendance. This has proved to be an effective way of validating the routine attendance data as well as assisting staff on site to resolve



PMDU staff during health facility spot checks

6: Over the 5 year period, PMDU working through the health sector, has realised significant achievements in improving attendance of health workers and teachers to their duties. In health, the average health worker attendance rose from the national average of 51% in June 2016 to 93% in February 2019 across the 20 pilot districts.

To improve the timeliness and integrity of attendance data and therefore productivity of workers, computers and biometric finger print readers have been installed in 225 health facilities; with full linkage and integration of biometric system reporting with existing Human resources information systems with funding support and technical assistance from DFID. PMDU and partner sectors have been able to transition the 20 pilot districts from paper-based self-reporting on attendance to use of biometric technology in order to improve data integrity, timeliness and use. The biometric systems which is currently being consolidated has proved to be effective in terms of real-time data reporting and integrity. The intervention has significantly impacted on staff attendance to duty in manner that government realizes value for money.

The 5 years of pilot efforts and consistent engagement of district authorities of the 22 districts have provided adequate lessons to inform scale up to the rest of the country. The funding support sought thus, will significantly lend its results to the overarching goal of improving the needed quality of health care as stipulated in NDP II1 and SDG 3. 


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