CCIH 2015 Tonny Tumwesigye Plenary 2

Uganda Protestant Medical Bureau
Contribution of UPMB in
Ending Extreme poverty
Dr. Tonny Tumwesigye
Executive Director
CCIH Annual Conference 26th – 29th June 2015

www.upmb.co.ug Health in Totality
Background
• Founded in 1957 by government notice no. 672
• National umbrella organization for Protestant,
Adventist and Pentecostal Founded member health
facilities.
• Health technical arm of the COU and the SDA Church
• 80% are in Rural & Hard to reach Areas
• It is one of the four religious medical bureau networks
in Uganda (UCMB, UMMB, UOMB)

UPMB Motto, Vision & Mission
• Motto:
– “Health in Totality”
• Vision:
– “Transformed lives through Christian quality health care”
• Mission:
– "Supporting members to witness for Christ through the
provision of quality health care“

Coverage of UPMB
18 Hospitals
10 Health Centre IV
255 Lower Level Health
Facilities
10 Health Training
Institutions
80% Very Hard to Reach
Areas
Private Not for Profit
Established following the
Need

Facilities across Uganda-(DHIS2 – GIS

UPMB Strategic Areas of focus (2014-2018)
1) Institutional Capacity Development
• Interventions like training and resource mobilization to improve
– HRH for member health facilities and Governance structures
2) Support to Health Service Delivery
• Concentrates on logistical and technical facilitation for MHF
– Infectious diseases e.g. HIV/AIDS and Reproductive health initiatives and
NCD
– Health Systems Strengthening-CHI
3) Patient Safety and Quality Health Services
• Looks at setting standards and monitoring compliance to them for
– Accreditation
– Patient safety promotion, ICT improvement and Support supervision
4) Research Advocacy and Networking

Historical feature of Uganda’s health system

Contribute to all health system building blocks
and levels of care

1. Policy, Leadership & Management
1. Policy development, monitoring and evaluation of the national plan
1. SWAp structures (PPPH) e.g. HPAC and District Fora
2. Medical Bureaus (Self-coordinating bodies)
3. NFB PNFPs
2. Leadership, Planning, coordination & Management of Health Services
– Through established coordination structures – Medical Bureaus
– 29 PNFP facilities are Health sub district headquarters
– Participation in DHMTs where the districts have actively involved them

2. Contribution to Health Infrastructure
1. 42% of the Country Hospitals
2. 42% of the Country Hospital Beds
3. About 65% of the institutions training
nurses/midwives in Uganda are PNFP
• 92% of these are under three Medical Bureaus

Hospitals HC IV HC III HC II Total
UCMB 32 6 172 75 285
UPMB 18 10 57 198 283
UMMB 5 2 22 21 50
UOMB 1 1 3 9 14
56 19 254 303 632
Other PNFPs 11 ? ? ?

3. Contribution to Hospital Capacity
No. of Hospitals Per cent
Government 65 41%
PNFP 67 42%
Private 27 17%
Total 159 100%
Other PNFP ?Data
Help to extend access to services to the people

4. Contributing to Human Resource Production
UCMB UPMB UMMB Total
Sites training Traditional Nurses and Midwifery 12 10 1 23
Sites training ECN 0 10 1 11
Sites training traditional EMW (cert) 12 10 0 22
Sites training traditional EMW (diploma) 3 3 0 1
Sites for cert. Laboratory Training 3 2 1 4
Sites for diploma Laboratory Training 3 1 0 6
Universities training Cos, Mos (UMU - Post grad) 1 1 0 2
Training in PH, Health Service Management (UMU &
UCU)
1 1 0 2
Training site for Government (University, Interns) 10 4 1 15

Recruitment & Posting of staff to MHFs
Personnel
Total No. of Staff 2013-
2014
Doctor 34
Clinical Officer/Medical Assistant 115
Lab Assistant 147
Enrolled Nurse 132
Enrolled Midwife/ECN 118
Registered Nurse 58
Total 607

5. Contribution to supply Chain
• Joint Medical Store-2nd Largest in the Country
– Started in 1979 (Peak of Uganda Health Crisis)
– Jointly by UPMB and UCMB
– PNFP facilities have not stopped procuring essential medicines from
JMS

6. Provision of the NMHC package by the PNFPs
E.g. OPD, In-patients and Deliveries
Health Facilities under UPMB also manage 10% of patients on Antiretrovi

7. Contribution To Health Resource Mobilisation
• Resources mobilised by the PNFP for work in health should be
considered as mobilised for Ugandans
– Mobilising from donors
– Mobilising local resources through user fees or Health Insurance
schemes (e.g. Community Health Insurance)-UPMB has the largest
CHI in Uganda
• Increasing support from government or donors helps reduce reliance
on user fees
• Reduction in support amidst increasing cost of service forces PNFPs to
increase user fees

45.8% 47.9% 49.9%
59.2%
7.6%
8.3%
11.5%
7.0%22.1%
21.5%
21.3%
22.0%
24.5% 22.3%
17.3%
11.8%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
FY 2010-2011 FY 2011-2012 FY 2012-2013 FY 2013-2014
UPMB Hospitals: Trends in income for recurrent operations
User Fees Gov't subsidy (Money & drugs) Donations Other incomes
60 – 80% of
donor funds
are for
HIV/AIDS, TB
and Malaria

60%
50%
46%
43%
35%
37%
32%
34% 33%
31%
35%
33%
39% 38%
41% 41%
0%
10%
20%
30%
40%
50%
60%
70%
97 98 98 99 99 00 00 01 01 02 02 03 03 04 04 05 05 06 06 07 07 08 08 09 09 10 10 11 11 12 12 13
Hospital Recurrent Cost Recovery Rate
(Median in UPMB Hospitals as example)
When
government
subsidy was
highest
Reducing
government
subsidy

8. Contribution to Innovation
• PBF
• In in Jinja diocese where it has been extended to
government facilities in Kamuli district with very good
results
• In Acholi sub-region supported by DfID
• Voucher system (UPMB) supported by Big Lottery UK
• Building maternal homes in hospitals to improve on
maternal health – a long time feature of some PNFP
facilities

9. Contributing to Quality Improvement Initiatives
• Having accreditation systems that could be adopted
nationally
• About 15 years experience now
• Production of Patient Safety Manual
• Annual Patients Satisfaction surveys
• Tools now also used by other organizations

10. Contributing to Health Technology
• Digitalising patient-level data collection in hospitals
• Capacity to feed data into DHIS2 built in some PNFPs to
below district level – HC II in some cases
• Digitalising patients satisfaction survey

www.upmb.co.ug Health in Totality25
11. Other areas of Contribution
• Provision of community based services
–Outreaches, home based care, (Community
Outreach Programs)
• More by the NFB – PNFPs
• E.g. 70% of HIV community-based prevention
work
• HFs also work with the NFB PNFPs

Major challenges
• High staff turnover rate
– Most departures are destined to government (60 –
70%)
– Some to Vertical Projects, mainly in HIV/AIDS

• Non Recognition by the State/being seen as
enemies and or Competitors
• Rising unit costs and total cost of service
provision
–Most people look at what patients pay but
not facilities spend beyond what patients
pay
–Amidst reducing government allocation to
facilities and severely reduced donor
funding

• Reduced support – end of credit line – affecting
capacity to procure
• Many facilities were shifted by MoH and some
grant conditionalities to procure HIV/AIDS
commodity from another supply chain
mechanism other than JMS

Recommendations
• We are not enemies of & Or competitors with the State but are
Complementing their role
• Study practices in other African counties like Zambia, Malawi,
Ghana etc to inform Government-PNFP partnership on HRH
• Performance-based financing (PBF) to be adopted both for the
PNFP and government facilities
• The capacity at JMS to be supported as the Supply-chain system for
the PNFPs
• Scale up Community Health financing

THANK YOU

CCIH 2015 Tonny Tumwesigye Plenary 2

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (20)

Similaire à CCIH 2015 Tonny Tumwesigye Plenary 2

Similaire à CCIH 2015 Tonny Tumwesigye Plenary 2 (20)

Plus de Christian Connections for International Health

Plus de Christian Connections for International Health (20)

Dernier

Dernier (20)

CCIH 2015 Tonny Tumwesigye Plenary 2