Health Sector Grant & Budget Guidelines FY 2019/20 Ministry of Health

Draft Health Sector Grant & Budget Guidelines FY 2019/20 focus on providing the highest level of health services in Uganda through various health interventions. The guidelines aim to accelerate progress towards universal health coverage, prioritize key strategic objectives, and address sector priorities for the financial year.

• Health
• Sector Guidelines
• Uganda
• Budget
• Ministry of Health

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1. DRAFT HEALTH SECTOR GRANT & BUDGET GUIDELINES FY 2019/20 MINISTRY OF HEALTH

2. MISSION TO PROVIDE THE HIGHEST POSSIBLE LEVEL OF HEALTH SERVICES TO ALL PEOPLE IN UGANDA THROUGH DELIVERY OF PROMOTIVE, PREVENTIVE, CURATIVE, PALLIATIVE AND REHABILITATIVE HEALTH SERVICES AT ALL LEVELS. HSDP GOAL ACCELERATE MOVEMENT TOWARDS UNIVERSAL HEALTH COVERAGE WITH ESSENTIAL HEALTH AND RELATED SERVICES NEEDED FOR PROMOTION OF A HEALTHY AND PRODUCTIVE LIFE

3. PURPOSE OF THE GUIDELINES TO PROVIDE GUIDANCE FOR THE BUDGETING AND UTILIZATION OF THE PRIMARY HEALTH CARE (PHC) GRANTS AND OTHER DECENTRALIZED HEALTH GRANTS IN FINANCIAL YEAR (FY) 2019/20. THESE GUIDELINES SHOULD BE USED TO PREPARE AND IMPLEMENT ANNUAL WORK PLANS FOR BOTH PUBLIC AND PRIVATE-NOT-FOR- PROFIT (PNFP) FACILITIES AS WELL AS PRIVATE HEALTH PROVIDER FACILITIES WHERE FEASIBLE / DESIRABLE.

4. STRATEGIC OBJECTIVES HSDP 2015/16 2019/20 1) TO CONTRIBUTE TO PRODUCTION OF A HEALTHY HUMAN CAPITAL FOR WEALTH CREATION THROUGH PROVISION OF EQUITABLE, SAFE AND SUSTAINABLE HEALTH SERVICES. 2) TO ADDRESS THE KEY DETERMINANTS OF HEALTH THROUGH STRENGTHENING INTERSECTIONAL COLLABORATION AND PARTNERSHIPS. 3) TO INCREASE FINANCIAL RISK PROTECTION OF HOUSEHOLDS AGAINST IMPOVERISHMENT DUE TO HEALTH EXPENDITURES. 4) TO ENHANCE THE HEALTH SECTOR COMPETITIVENESS IN THE REGION AND GLOBALLY.

5. SECTOR PRIORITIES FOR FY 2019/20 ADDRESSING THE HUMAN RESOURCE CHALLENGES IN THE SECTOR (ATTRACTION, MOTIVATION, RETENTION, TRAINING AND DEVELOPMENT). STAFFING LEVEL IS AT 73% I.E. 45,029 OUT OF THE 61,796 APPROVED POSTS FILLED IN THE PUBLIC SECTOR (SOURCE 2016/17 AHSPR). TARGET IS TO INCREASE TO AT LEAST 80% IN 2019/20 WAGE ENHANCEMENT (150 BN) AS ANNOUNCED TO BE EFFECTED IN 2018/19 SCHOLARSHIPS TO BE AWARDED FOR CRITICAL CADRES E.G. ANESTHETISTS, THEATER ASSISTANTS, BIOMEDICAL ENGINEERS, SPECIALISTS WITH FOCUS ON OBSTETRICS & GYNAECOLOGY AND GENERAL SURGERY (CURRENTLY 182 UNDER URMCHIP) STAFF ACCOMMODATION ESPECIALLY AT HC IIIS STARTING WITH HARD TO REACH AREAS PERFORMANCE MANAGEMENT WITH FOCUS ON REDUCING ABSENTEEISM & ACTUAL OUTPUTS BY INTRODUCTION OF BIOMETRIC ATTENDANCE REGISTRATION AND PERFORMANCE AGREEMENTS FOR ALL MANAGERS

6. SECTOR PRIORITIES FOR FY 2019/20 IMPROVING HEALTH INFRASTRUCTURE WITH KEY FOCUS ON HEALTH CENTER III S AND SOME GENERAL HOSPITALS & HC IVS. BY 2020 ALL SUBCOUNTIES MUST HAVE FUNCTIONAL HC IIIS URMCHIP UPGRADE 41 HC IIS TO HC IIIS & FUNCTIONALISE 40 HC IIIS IN 56 DISTRICTS INTER GOVERNMENTAL FISCAL TRANSFER PROGRAM UPGRADING HCIIS TO IIIS AS WELL AS HEALTH INFRASTRUCTURE MAINTENANCE GOU & SPANISH DEBT SWAP RECONSTRUCTION & EQUIPPING OF KAWOLO & BUSOLWE HOSPITALS. GOU & SAUDI FUND/OFID AND BADEA - EXPANSION, REHABILITATION, AND EQUIPPING OF YUMBE & KAYUNGA HOSPITALS

7. SECTOR PRIORITIES FOR FY 2019/20 ENHANCE HEALTH EDUCATION AND PROMOTION TO ENSURE THAT COMMUNITIES, HOUSEHOLDS AND INDIVIDUALS ARE EMPOWERED TO PLAY THEIR ROLE AND TAKE RESPONSIBILITY FOR THEIR OWN HEALTH AND WELL-BEING BY LINKING COMMUNITIES TO HEALTH FACILITIES USING THE COMMUNITY HEALTH EXTENSION WORKERS (CHEWS) SHS. 3.2 BN HAS BEEN ALLOCATED FOR PAYMENT OF HONORARIA FOR 1,500 CHEWS IN FY 2019/20. TRAINING OF CHEWS WITH SUPPORT FROM THE HEALTH DEVELOPMENT PARTNERS (WHO, UNICEF, UNFPA, SIDA) FOCUS ON HEALTH PROMOTION, PREVENTION AND EARLY INTERVENTION WITH FOCUS ON IMPROVING HYGIENE AND SANITATION, INTEGRATED COMMUNITY CASE MANAGEMENT OF COMMON CONDITIONS

8. SECTOR PRIORITIES FOR FY 2019/20 IMPROVEMENT OF REPRODUCTIVE, MATERNAL, NEONATAL, CHILD AND ADOLESCENT HEALTH SERVICES TO REDUCE MORTALITY AND MORBIDITY AND IMPROVE THE HEALTH STATUS. IMPLEMENTATION OF THE REVISED SHARPENED PLAN FOR RMNCAH WITH SUPPORT FROM PARTNERS AS WELL AS THROUGH THE URMCHIP SCALE UP THE RESULTS BASED FINANCING APPROACH TO INCENTIVIZE HC IIIS & IVS, TO EXPAND THE PROVISION OF QUALITY AND COST-EFFECTIVE RMNCAH SERVICES. STRENGTHEN INSTITUTIONAL CAPACITY TO DELIVER RMNCAH SERVICES IMPROVED SUPPLY OF EMHS, AVAILABILITY & MANAGEMENT OF THE WORKFORCE, AVAILABILITY & FUNCTIONALITY OF MEDICAL EQUIPMENT, IMPROVED QUALITY OF CARE & SUPERVISION

9. SECTOR PRIORITIES FOR FY 2019/20 REDUCE STOCK OUTS OF EMHS REDUCE STOCKS OF EXPIRED DRUGS FROM FACILITIES BY IMPLEMENTING A STRATEGY FOR MINIMIZING EXPIRY OF MEDICINES AND MOBILIZING RESOURCES FOR DISPOSAL OF EXPIRED MEDICINES. ADVOCATING FOR INCREASED ALLOCATIONS FOR MEDICINES AND LABORATORY SUPPLIES AND REAGENTS.

10. SECTOR PRIORITIES FOR FY 2019/20 SCALING UP INTERVENTIONS TO ADDRESS THE HIGH BURDEN OF HIV/AIDS, TB, MALARIA, NUTRITIONAL CHALLENGES, ENVIRONMENTAL SANITATION AND HYGIENE, IMMUNIZATION, HEPATITIS B AND NON COMMUNICABLE DISEASES GFTAM GAVI DISTRICT HEALTH SANITATION GRANT

11. SECTOR PRIORITIES FOR FY 2019/20 ENHANCING BLOOD COLLECTION BY THE UGANDA BLOOD TRANSFUSION SERVICES. STRENGTHEN THE COMMUNITY RESOURCE PROGRAM THROUGH ENHANCE BLOOD DONOR EDUCATION TO SCALE UP DONOR BASES CREATE A BLOOD COLLECTION/ BLOOD DISTRIBUTION FACILITY IN MOROTO REMODEL AND EXPAND THE COLD ROOM FOR BLOOD STORAGE TO ACCOMMODATE 9,200 UNITS AND STORES FOR MEDICAL SUPPLIES. PROCURE 4 BLOOD COLLECTION VANS

12. SECTOR PRIORITIES FOR FY 2019/20 EFFECTIVE AND WELL-STRUCTURED SUPPORT SUPERVISION TO THE LOCAL GOVERNMENTS HARMONIZED WITH THE REGULATORY AUTHORITIES INCLUDING THE PROFESSIONAL COUNCILS IMPLEMENTATION OF A SUPPORT SUPERVISION STRATEGY BASED ON THE SIX BUILDING BLOCKS CONTINUOUS QUALITY IMPROVEMENT

13. SECTOR PRIORITIES FOR FY 2019/20 CONTROL / PREPAREDNESS FOR DISEASE OUTBREAKS INCLUDING SURVEILLANCE WEEKLY DISEASE SURVEILLANCE & REPORTING TIMELY RESPONSE TO DISEASE OUTBREAKS

14. SECTOR PRIORITIES FOR FY 2019/20 MOBILIZING SUFFICIENT FINANCIAL RESOURCES TO FUND THE HEALTH SECTOR PROGRAMS WHILE ENSURING EQUITY, EFFICIENCY, TRANSPARENCY AND MUTUAL ACCOUNTABILITY. STRENGTHENING PARTNER COORDINATION AND ESTABLISHING EFFICIENT RESOURCE MAPPING & TRACKING MECHANISMS

15. SECTOR PRIORITIES FOR FY 2019/20 ESTABLISHMENT OF THE NATIONAL HEALTH INSURANCE SCHEME IMPLEMENTATION OF THE NHIS ACT DEVELOPMENT OF THE REGULATIONS ESTABLISHMENT OF THE MANAGEMENT STRUCTURE ADVOCACY AND COMMUNITY AWARENESS CREATION COSTING OF THE BENEFITS PACKAGE

16. STRUCTURE AND PURPOSE OF HEALTH GRANTS Purpose Grant PHC Wage Conditional Grant To pay salaries for all health workers in the district health service including health facilities, District & Municipal health offices. To fund service delivery operations by the health department supervision, management, and epidemic preparedness District & Municipal Health Office PHC Non-Wage Conditional Grant PHC Health Centres To fund service delivery operations by the health centres, both government and Private Not For Profit (PNFP) Hospital To fund service delivery operations by hospitals both government and PNFP To fund sanitation related activities such as community sensitizations and advocacy In FY 2019/20, this will fund the Upgrading of HC IIs to IIIs, general operation & maintenance of health infrastructure & equipment. Transitional Development Sanitation Health Development (IGFT) Grant

17. PHC Wage Conditional Grant STAFF OF THE DISTRICT/ MUNICIPAL HEALTH OFFICE AND HEALTH CARE SERVICE DELIVERY STAFF SHOULD BE PAID FROM THE SECTOR CONDITIONAL WAGE GRANT. SALARY ALLOCATIONS TO HEALTH FACILITIES MUST BE ACCORDING TO THE FILLED POSTS WITHIN THE APPROVED STRUCTURE, RECRUITMENT PLAN AND SALARY SCALES. THE HARD-TO-REACH ALLOWANCE EQUIVALENT TO 30% OF A MEMBER OF STAFF S SALARY MUST BE PROVIDED FOR STAFF IN THE HARD-TO-REACH AREAS, IN LINE WITH THE HARD-TO-REACH FRAMEWORK & SCHEDULE DESIGNATED BY THE MINISTRY OF PUBLIC SERVICE. THE HEALTH DEPARTMENT MUST PREPARE A RECRUITMENT PLAN AND SUBMIT IT TO THE CAO / TOWN CLERK FOR THE VACANT POSITIONS.

18. ALLOCATION FORMULA FOR NWR GRANTS IN 2019/20 FY IN FY 2019/20, THE IPFS FOR PHC NON-WAGE RECURRENT GRANTS FOR HOSPITALS AND PHC FACILITIES SHALL BE BASED ON A NEW ALLOCATION FORMULA DEPENDANT ON THE AVAILABILITY OF ADDITIONAL RESOURCES UNDER THE IGFTR PROGRAM

19. ALLOCATION FORMULA FOR PHC NWR GRANTS FOR FY 2019/20 Variable Weighting Population 60 Population represents the overall target beneficiaries, and is an indicator of demand for health services and the scale of services required Infant Mortality 8 Equalizing health outcomes: most of the causes of infant mortality are preventable using already proven interventions. These include immunisation, ORS, nutrition and hygiene. Therefore strengthening the health system will address the causes that enhance disparities in IMR. Poverty Headcount 2 Approximates socio-economic goal of increasing access for poorer communities Fixed Allocation 4 A fixed allocation to cover the running of the health department. Number of HC IVs & IIIs and HC IV, with 30% going to HC III and 70% to HC IV. Population in Hard to Reach Hard to Stay Areas be high. Justification 24 A constant amount to cover the fixed cost of running a HC III 2 Mountainous, islands, rivers etc. have peculiar terrain. Provides greater allocations to areas where costs are likely to

20. ALLOCATION FORMULA FOR HOSPITAL NWR GRANTS FY 2019/20 Variable Weighting Population of HLGs with Public or PNFP Hospitals services required. Justification 82 Population of districts with hospitals represents a proxy for demand for hospital services and the scale of Infant Mortality 10 Equalizing health outcomes: most of the causes of infant mortality are preventable using already proven interventions. These include nutrition and hygiene. Therefore strengthening the health system will address the causes that enhance disparities in IMR. immunization, ORS, Poverty Headcount 2 Approximates socio-economic goal of increasing access for poorer communities. Fixed Allocation 6 A fixed allocation to cover the running of the hospital

21. PERFORMANCE BASED ALLOCATION To enhance service delivery outcomes, in FY 2019/20, the allocation to health facilities will depend on their standard unit of outputs (aggregate performance). MoH is coordinating with OPM in developing the system for assessing service delivery results.

22. Transitional Development Grant Sanitation THIS DEVELOPMENT GRANT SHALL BE ALLOCATED CENTRALLY TO LGS THAT ARE IMPLEMENTING THE UGANDA SANITATION FUND (USF) PROGRAMME. THE GRANT SHOULD FUND SANITATION RELATED ACTIVITIES SUCH AS COMMUNITY SENSITIZATIONS AND ADVOCACY WORK THAT CONTRIBUTE TO THE REDUCTION OF MORBIDITY AND MORTALITY RATES FROM SANITATION-RELATED DISEASES.

23. Health Development Grant IGFTR In line with the second National Health Policy, and as directed by His Excellency the President, the health sector will focus its efforts towards establishing a functional HC III per Sub County across the country in the medium term. Currently, there are 331 Subcounties/Town Councils/Divisions with no HC III but have a HC II that can be upgraded. 124 HC IIs were allocated funding for upgrade to HC IIIs in FY 2018/19. The remaining health facilities for upgrade will be done in a phased manner in the subsequent years.

24. HEALTH DEVELOPMENT GRANT ALLOCATION THE DEVELOPMENT GRANT ALLOCATION FORMULA WILL HAVE TWO COMPONENTS: 1. THE BASIC COMPONENT ALLOCATED BASED ON THE BASIC ALLOCATION CRITERIA I.E. 50% OF THE GRANT; AND 2. THE PERFORMANCE COMPONENT BASED ON THE RESULTS OF THE LOCAL GOVERNMENT PERFORMANCE ASSESSMENT SYSTEM I.E. 50% OF THE GRANT

25. Health Facility Level Budgeting and Implementation Guidelines EACH HEALTH FACILITY IS REQUIRED TO PREPARE A DETAILED ANNUAL WORK PLAN AND BUDGET FOR THE NEW FY BY THE 30THJULY IN LINE WITH THE MOH GUIDELINES FOR THE LG PLANNING PROCESS FOR THE HEALTH SECTOR LGS THAT SHOWS; ALL PLANNED ACTIVITIES INPUTS KEY OUTPUTS AND INDICATORS TIME FRAME SOURCE OF FUNDS RESPONSIBLE PERSONS AND ASSUMPTIONS ALL EXPECTED REVENUES FUNDS RECEIVED AND ACTUAL EXPENDITURES/ ACTIVITIES FOR THE PREVIOUS FY.

26. Health Facility Level Budgeting and Implementation Guidelines THE BUDGET AND ANNUAL FINANCIAL STATEMENT MUST INCLUDE FUNDS FROM; a) NWR GRANT FOR THE NEW FY b) REVENUE AND EXPENDITURE FROM CENTRALLY COORDINATED PROGRAMS / PROJECTS DIRECTLY TO HEALTH FACILITIES c) REVENUE AND EXPENDITURE FUNDED BY DONORS DIRECTLY TO HEALTH FACILITIES AND d) ALL OTHER SOURCES, IF ANY. THIS INCLUDES DONATIONS RECEIVED FROM WELL-WISHERS BOTH IN CASH, IN KIND (VALUES TO BE IMPUTED), FROM FUNDRAISING EFFORTS, ETC.

27. You Thank For Your Attention