Close

HEALTH Thematic Area

The Health Thematic Area - Our Journey Our Story
pmduhost pmduhost

The Health Thematic Area - Our Journey Our Story

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. PMDU’s focus in health has been improving health workforce productivity through daily tracking of staff attendance to duty and supporting the districts institutionalize attendance data use in order to inform management decisions. Other considerations for elimination of absenteeism through attendance tracking were Impacts of absenteeism on HEALTH services namely

    Absenteeism Prevents communities from accessing timely care
    Increased costs due to multiple attempts to access care
    Worsening Patient conditions lead to additional costs
    Worsening health conditions kill trust in the health system
    Increased volume of work for those present
    Low morale, workers present adopt negative practices
    Some are forced to perform tasks for which they are unqualified

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

A: Delivery actions

I.    Engagements with Political and Technical Sector-specific leaders at Central level and in the 22 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.

OPM/PMDU leadership with leaders of the 20 districts following a successful engagement in 2019

II.    Establishment and operationalization of 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.  

III.    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. The collaborating ministries and departments include Health, Ministry of Local Government, Ministry of Public service, Health development and Implementing partners with operations in the 20 focus districts 

Former Rt. Hon. PM with Top leadership of the collaborating sectors following a successful sector stock take in 2019 and below are 

IV.    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. The stock takes have been institutionalized in the 22 pilot districts

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 and recognition of good performance such as promotions, handshakes and assorted awards at end of year parties.

V.    Monthly Briefings to the Rt. Hon. Prime Minister and Permanent secretaries of the collaborating sectors
This another PMDU’s routine whereby the Rt. Hon Prime Minister is updated on progress and emerging service delivery issues on a monthly basis 
 

VI.    Technical thematic area staff visit randomly selected health facilities without prior notification and perform spot checks on attendance. As part of our routines, PMDU on a quarterly basis carries out spot checks in randomly selected HFs without prior notification. These visits are intended to ascertain Atta dance on spot, availability of power and water utilities as enablers of service delivery, identify constraints or problems that affect service delivery and maintenance of a functional relationship with the district local governments among the aspects. PMDU has included COVID-19 vaccination status and availability of adequate PPEs since the beginning of the COVID-19 Pandemic. This has proved to be an effective way of validating the routine attendance data as well as assisting staff on site to resolve implementation problems 

B: Achievements/successes

VII.    Over the 5 year period, PMDU working closely with the health sector, has realised significant achievements in improving attendance of health workers and teachers to their duties. 
 

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. 

Also as part of PMDU 3 pronged strategies, routine attendance data is collected using the existing infrastructure within the districts and the HRIS system at the Ministry of Health. This is analyzed and feedback given periodically to drive accountability and inform continuous service delivery improvement.  

 
VIII.    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.  A total of 221 HFs in the 22 Pilot districts receive biometric tracking equipment namely Wall mount biometric machines and computers for General district hospitals and HC IVs and Mobile Biometric phones for HC IIIs

IX.    Utilization of attendance data for management decisions: 
Consistent with the principles of performance management as stipulated in the Civil Service Code of Conduct and Performance management guidelines, annually recognizes districts that have consistently submitted reports on actions taken against staff who violet the guidelines including absentee staff and; those that have been reward for good performance 
At the 2021 Stock take in Mbale city, the following districts: Kayunga, Manafwa and Sironko received awards for consistent utilization of attendance data over the 5 years to inform management decisions
 

IX.    Utilization of attendance data for management decisions: 
Consistent with the principles of performance management as stipulated in the Civil Service Code of Conduct and Performance management guidelines, annually recognizes districts that have consistently submitted reports on actions taken against staff who violet the guidelines including absentee staff and; those that have been reward for good performance 
At the 2021 Stock take in Mbale city, the following districts: Kayunga, Manafwa and Sironko received awards for consistent utilization of attendance data over the 5 years to inform management decisions

The 6 Districts came out with outstanding Clientele satisfaction scores. These districts scored way above the National Health Sector Development National Plan Target of 50%. Three of them are Hard to reach, Hard to work, hard to stay, hard to live. The 6 received plaques, certificates of recognition and handshakes with Rt. Hon. PM at the 2021 Prime Minister’s stock take. 
 
1)    Sironko: 100% score ; 2) Kapchworwa 100%;  3) Bududa 97.3%; Mayuge, 88%; Mbale 76.2% and Luuka 72.7%

Additional awards on Client satisfaction were given to 3 others districts that scored above the overall National Score of 31.8% namely
2)    Manafwa: 41.1%; Serere: 38.5%  and Buyende: 32.4% 

Overall, the best performing district in health was Sironko 
Whereas a number of districts have had challenges in generating and utilizing biometric attendance data, the focal point person in Sironko district has been exemplary in generating this data as well as mentoring and supporting others within the Bugisu region. Sironko district met all the 3 criteria elements PMDU considered for selection of good performance namely
o    Clientele satisfaction with medical services
o     Utilization of attendance data to Inform management decisions including S&R
o    Good Health worker attendance to Duty statistics over the years
 

C: Key lessons learned
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. 

    Continuous monitoring improves performance
    Using and sharing data more helps to drive actions and improvements
    Follow through with districts is key to ensuring actions taken
    Coordinating across stakeholders has been key in ensuring a joint approach to systemic improvement - Inter-ministerial Task Force

GoU has made a commitment to scale up the deliverology methodology to the entire country. This 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.  

Print
1874 Rate this article:
No rating
Please login or register to post comments.

Contact Us

Plot 9-11 Apollo Kaggwa Rd
P.O Box 341 Kampala

TELEPHONES

Office: +256 41-7770500

Toll-Free: 0800-100-350
Fax: +245-41-4341139

Email: ps@opm.go.ug


Links

Terms Of UsePrivacy StatementMaintained by Bytecognition.com Copyright 2024 by Prime Minister's Delivery Unit
Back To Top