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THE R.LPUBLIC OF UGANDA Office of the Ministe r of Health P.O.

Box 7272 Kampala Uganda MH/H/02 27'h February, 2019.

The Clerk to Parliament, Parliament of Uganda, KAMPALA.

Dear Madam, RE: STATEMENTS TO PARLIAMENT Find attached herewith Statements to Parliament which are due for discussion.

1.
1.

The Need for Evaluation of the Capacity of Mbarara Regional Referral Hospital with a View of Improving its capacity to Deliver Quality Health Care Services; 2. lack of Ernergency Interventions on Highways; 3.

Rising Maternal and Neonatal Mortality Rates and The Need for Increased Resource Allocation to Maternal and Neonatal Health.

Yours sincerely, Dr. Ac MINISTER Jane Ruth Cc Cc Cc Cc Cc Cc Cc The Rt.

Hon.

Speaker of Parliament The Rt.

Hon.

Prime Minister The Government Chief Whip Hon.


Minister of State for Health (General Duties) Hon.

Minister of State for Health (PHC) Permanent Secretary, Ministry of Health Ag.

Director General Health Services THE REPUBLIC OF UGANDA MINISTRY OF HEALTH STATEMENT TO PARTIAMENT ON THE NEED FOR EVATUATION OF THE CAPACITY OF MBARARA REGIONAL REFERRAL HOSPITAL WITH A VIEW OF IMPROVING ITS CAPACTTY TO DETIVER qUALITY HEALTH CARE SERVICES.

Hon, Aceng Jane Ruth Minister for Health February 26,?OLg Rt.

Hon.
Hon.

Speaker of Parliament Honourable Members of Parliament Hon.

Doniozio Kahonda, MP Ruhinda County raised a motion at the floor of Parliament requesting a clarification on need for evaluation of the capacity of Mbarara Regional Referral Hospital with a view of improving its capacity to deliver quality health ca re services.

Rt.

Hon.

Speaker, Mbarara Regional Referral Hospital was built in early 1950 as a District Hospital serving approximately 500,000 people in Ankole region.
Currently, the hospital serves an estimated population of over 3.6 million people and is a referralfacility for the 10 Districts of; Mbarara, lsingiro, Bushenyi, Sheema, Rubirizi, Mitooma, lbanda, Kiruhura, Buhweju and Ntungamo (Ankole Region).

ln addition, Mbarara Hospital receives referrals from Kigezi, Rwenzori Region as well as from the neighboring countries of Rwanda, Tanzania and Democratic Republic of Congo (DRC).
Mbarara Hospital is also the teaching Hospital for Mbarara University of Science and Technology (MUST) and receives students from other tertiary training lnstitutions which includes; Bishop Stuart University, Mayanja Memorial lnstitute and others from across the country.

The faculty of Medicine of Mbarara University through a Memorandum of Understanding provides a total of 62 highly trained Doctors (specialists) who support clinical work in the hospital.
The hospital was formally under Ministry of Education - Mbarara University of science and Technology (MUST) till 2005 when it was reverted to Ministry of Health as a Regional Referral Facility for Ankole Region.

Rt.

Hon.

Speaker, the Ministry of Health's plan is to upgrade Mbarara Regional Referral Hospital to a National Referral Hospital in three phases.
The first phase which was successfully completed, covered the construction of 8 operating theatres, 8 bed intensive care unit, construction and equipping of accident and emergency unit, Radiology unit, post-operative executive rooms and Medicine storeS.

Underthis phase, the hospital was provided with modern digital x ray machine, a CT scan and later an oxygen plant and central suction (Vacuum).

This upgrade of the hospital greatly improved the hospital thus attracting more referrals from the region.
The Znd and 3'd phases of the hospital will include the construction and equipping of; Administration Block, all the wards including Maternity, Pediatrics, Surgical and Medicalwards, Mbarara Regional Referral Hospital provides the following services; A.

Surgery P General Surgery ) Neuro SpinalSurgery ) Cardio Thoracic Surgery.
F ophthalmology P Ear Nose Throat ( ENT) F Orthopedic surgery B. Obstetrics /Gynaecology ) General Obs and Gynae F General Maternal Child Health D WF repairs ) Cervical Cancer surgery C. Pediatrics F Neonatal Pediatrics ) lntensive ca re ) Neonatal and premature babies care ) General Pediatrics and nutrition and rehabilitation D. Medicine ) Nephrology ) Cardiology ) lntensive ca re P Accident and emergency ) Specialized and critical care Nursing F Oncology Mbarara Regional Referral Hospital has a staffing level of 85% (structure of 377) with an interim structure of regional referral hospital which is inadequate for the population and also does not appropriately address the specialists teaching positions needed for hospital with a medical school.
Discussions are ongoing with Ministry of Public Service to consider revising the staffing structure for all Hospitals.

Rt.

Hon, Speaker, Mbarara Regional Referral Hospital also has an ongoing project to improve disease diagnosis which is; construction and equipping of the state of the art la boratory u nder the East African Pu blic Hea lth La boratory Networks Project (EAPHLNP) and is due for completion by July 20L9.
The laboratory will improve quality of care in areas of TB, cancer, hematology and routine laboratory screening tests.

Rt.

Hon.

Speaker, the Ministry of Health is in the final stages to provide Medical equipment for all Regional Referral Hospitals under the DRIVE Project.

Mbarara Regional Referral Hospital will be provided with equipment in various units which include: .

Accident and Emergency Unit o lntensive Care and High Dependency Unit .
Operation Theatre r Radiology to include: CT Scan, CT simulator, Linear accelerator, Brachy Therapy and MRI .

Dialysis Unit This will enable the hospital to achieve its vision of a center of excellence and ultimately transform into a National Referral hospital.

Rt.

Hon.

Speaker, the other plan is to have Mbarara Regional Referral Hospital operate as a regional cancer and heart center, The Cancer center is already started with 20,000 cancer patients in their cancer register.
These centers of excellence will serve the overwhelming numbers of cancer and heart patients in the region.

However, Rt.

Hon.

Speaker, the following challenges should be noted: 1) Restrictive hospital structure that limits human resources recruitment.

2) lnadequate space for inpatients leading to congestion of patients in the hospita l. 3) Limited Capital Development Budget for phase 2 and 3.

Thank you.

Hon.
Thank you.

Hon.

Dr. AcengJane Ruth Minister for Health FOR GOD AND MY COUNTRY THE REPUBLIC OF UGANDA MINISTRY OF HEALTH STATEMENT TO PARLIAMENT- LACK OF EMERGENCY INTERVENTIONS ON HIGHWAYS Hon.

Dr. Aceng Jane Ruth Minister for Health February 12,?OLg 1 Rt.

Hon.

Speaker of Parliament Honourable Members of Parliament At the 5th sitting of the 3,d meeting of the 3'd session of the 10th Parliament of Uganda held on Tuesday 22nd January, 2019, Hon.
Abala David MP, Ngora County raised Concern over lack of emergency interventions when accidents occur on Highways.

He cited an example of an accident that had occurred in soroti where emergency facilities including blood could not be provided to the accident victims.

Rt.

Hon Speaker, Ministry of Health recognizes the challenges faced by accident victims in accessing continuous care in facilities along the highways.
Regional Referral Hospitals situated on these highways like Gulu, Kabale, Mubende, Lira, Mbarara, Moroto, Hoima, Fort Portal, Masaka, Jinja, Mbale, and General Hospitals like Kawolo, Kiryadongo, ltojo, lganga, Luweero, Gombe, Bullisa, Mityana, Atutur and Bwindi receive accident cases on a daily basis.

The Ministry of Health has prioritized establishment of an Emergency Medical Services System to respond to emergencies on highways.
This has been put in place with support from key partners both international and local including Development Partners, Uganda Police Forces (UPF), Uganda People's Defense Forces (UPDF), Kampala City Council Authority (KCCA), Private Sector, and Non-Government Orga nizations.

The Emergency Medical services System operates at 3 levels of care that must be well planned and coordinated for an effective emergency care response to road traffic accidents.
These include; Scene Care, Transport Care (Ambulance Services) and Health Facility Care.

Rt.

Hon.

Speaker and Hon.
Members, a number of achievements have been made in the area of emergency care services include the following; o Establishment of Accident and Emergency units at Regional Referral Hospitals on highways and equipped them with health supplies and eq u ipment, 2 a a a a With support from the World Bank under UHSSP, we rehabilitated and equipped 8 General Hospitals with high grade ambulances, 6 of which are highway hospitals including Kiryandongo, Mityana, Anaka, Entebbe, Nebbi lganga and Moroto Regional Referral Hospital.
ln addition, this FY 2018119, with support from the Spanish Government under the Spanish loan funding, Kawolo hospital is undergoing renovation with expansion of the accident and emergency unit in order to respond effectively to the high toll of emergencies on that high way.

There will be an ambulance bay, a fully equipped emergency ward and trained medical staff in emergency care response.
With support from partners like BADEA, Saudi Fund for Development and OPEC Fund for lnternational Development under the Kayunga-Yumbe Project, Ministry of Health will fully rehabilitate and equip both hospitals including the Accidents and Emergency Units and equipment.

Currently Ministry of Health has established an Emergency Care System at Masaka Regional Referral Hospital covering 9 Districts with support from the Korean Government through the Korean Foundation for lnternational Health (KOFTH).

Rt.
Rt.

Hon.

Speaker, o Regional Referral Hospitals including soroti, are in a better position to offer emergency care services to accident victims.

However, functionality of these Accident and Emergency units vary from hospitalto hospital as dictated by other factors ranging from staffing levels, supplies and equipment.
To address this, this Financial Year 2078/2019, Ministry of Health will receive a grant from the Dutch government of 23 million Euros and a quarterly co-financing from government of Uganda totaling to 25 million Euros over 5 years to reequip all the 13 Regional Referral Hospitals in the country.

Under this program, Ministry of Health will procure imaging, x-ray, intensive care and emergency medical equipment for the Regional Referral Hospitals to enhance their capacity.
The hospitals will receive, CT scans, X-rays, theatre equipment among others.

3 Rt.

Hon.

Speaker, Government has priorltized strengthening of the Uganda Blood Transfusion Services (UBTS), this FinancialYear 2018/19 UBTS increased its target for blood collection to 300,000 units of blood up from 240,000 for last FY.
The increase in target was based on the overall demand from the hospitals of 260,000 units of blood in the FY 2017 /ZOt8 and this is envisaged to handle the ever growing demand of blood by patients partly due to road traffic accidents.

A tracking system for blood is under development to monitor every unit and its use.
o The Ministry has also trained 598 health workers from Regional referral hospitals, General hospitals and highway HCIVs in Basic emergency care so that they are able to provide emergency medical response when required.

The Highway health facilities were priorltized during the training with at least 5 staff trained per health facility on average.
o ln order to build emergency responsive capacity of Hospitals, in 2O17 /18 FY, the Ministry of Health awarded 1,4 scholarships for emergency physicians and 15 for diploma level in emergency medicine' These are undergoing training and will be back to fill the gaps.

.

ln partnership with Lubaga hospital training institute and Malteser international, a diploma course for emergency care responders will start next financialyear.
a Ministry of Health procured 19 ambulances and trained emergency care responders under the UHSSP project (FY2OL2/13 - 2075116\ supported by World Bank which were stationed at Mubende, Moroto, Kiryandongo, Masindi, Entebbe, Lyantonde, Nakaseke, Mityana, Buwenge, Apac, Kitgum, Anaka, Moyo, Nebbi, Bwoko, ltojo, Pallisa, Bugiri and lganga hospitals.

All these ambulances are functional and in good condition.
a Ministry of Health also procured 11 ambulances and trained emergency care responders under the BTC project supported by the Belgium Government that were supplied to the Districts of; Adjumani, Maracha, Yumb, Zombo, Koboko, Bundibugyo, Kabarole, Kasese, Kyegegwa and Ntoroko.

4 THE REPUBLIC OF UGANDA MINISTRY OF HEALTH STATEMENT TO PARLIAMENT ON THE RISING MATERNAL AND NEONATAT MORTALITY RATES AND THE NEED FOR INCREASED RESOURCE ATLOCATION TO MATERNAT AND NEONATAT HEALTH.

Hon.
Hon.

Dr, AcengJane Ruth Minister for Health February 5 2019 Rt.

Hon.

Speaker of Parliament Honourable Members of Parliament Hon.

Bamukwanzira-Muzanira Betty raised a motion on the floor of Parliament requesting clarification on the rising numbers of maternal and neo-natal mortality rates in the Country and to justify for increased resource allocation from government to maternal and neonatal health.

Rt.

Hon.
Rt.

Hon.

Speaker and Honorable Members of Parliament whereas it is true that the maternal deaths in the country are still high, Uganda has made progress in reducing Maternal mortality which declined from 505 deaths per 100,000 live births (1995), 438 deaths per 100,000 live births (2011) to 335 per 100,000 live births (2016).

Also newborns dying have reduced from 33 per 1,000 live births (2001) to 27 in LOOO live births (2016).
The Health Sector target is to reduce maternal mortality to 320 per 100,000 live births and perinatal mortality rate to 16 per 1000 live births by 2020. lt is therefore not true that maternal Mortality and neonatal mortality are rising.

What is true is that progress in reduction is slow.

The most common direct causes of maternal deaths; .

Bleeding at time of delivery (Haemorrhage ,35.2%) .

Obstructed labour/ruptured uterus (13.3%) .

High blood pressure (Hypertensive disorders, 12.5%) .
lnfections (Sepsis, 8.9%) While, the common direct causes of neonataldeaths are: .

Failure to breath at birth (birth asphyxia,68.3%l .

Prematurity $3.6%l .

lnfections (Septiceamia, 9.3%) The main underlying factor to cause of the death is delay of the woman to seek heath care which contributes 42% of causes of maternal deaths.

Rt.

Hon.
Rt.

Hon.

Speaker, Government developed the Sharpened plan or the RMNCAH - lnvestment case for the period 2Ot6 - 2020 that provides the Country with a resource mobilisation platform.

The investment case tracks not only national targets but also SDG targets for maternal and newborn health.

The plan aims to prevent death of another 6,350 Mothers, 30,600 newborn and 57,500 children (2 - 59 Months).

lt also identifies priority cost effective interventions and bottlenecks for funding.
FINANCING OF MATERNAL NEWBORN CHILD AND ADOLESCENT HEALTH Rt.

Hon.

Speaker, the National Health financing strategy (NHFS) identifies results based financing (RBF) as one of the mechanisms to improve Sector efficiency and accountability by focusing on strategic purchasing of verified RMNCAH - outputs both in qualityand quantity.

ln addition it providesforthe creation of a basket Fund to align and harmonise donor funding for RMNCAH interventions in the sharpened plan/lnvestment case.
ln July, 2015 Uganda was chosen as one of the 8 countries globally to receive support from the Global Financing Facility (GFF) Trust in support of Every Woman Every Child.

This movement is a country - driven partnership that aims to accelerate efforts to end preventable maternal, newborn, child and adolescent deaths and improve their health and quality of life.
The GFF Trust Fund also aims at mobilizing additional funding from dedicated multi-donor funding sources such as the lnternational Development Association (lDA) of the World Bank, additional domestic and external resources.

Financing of the Sharpened Plan/lnvestment case The estimated cumulative - cost of the sharpened plan is USD 1,875 million over a five year period with a total investment funding gap for the 5 years estimated at USD 500 million.
Currently, there are two distinct sources of funds for RMNCAH.

a) Uganda Reproductive Maternaland Child Health services lmprovement Project (URMCHIP): World Bank financing from both IDA and GFF Trust Fund amounting to USD 165 million.

b) lnter-Government FiscalTransfers (IGFT) amounting to USD 200 million over a 4 years period.

A.
A.

The URMCHIP Project Government acquired a Financing grant amounting to USD 165 million towards implementation of the Uganda Reproductive Maternal and Child Health services lmprovement Project (URMCHIP) that provided catalytic funding to the implementation of the lnvestment case.

Of the total grant, USD 110 million is from the lnternational Development Association (lDA) of the World Bank, USD 30 million is from the Global Financing Facility (GFF) and USD 25 million ls from the Swedish government (Sida).
The Project was signed off by Government of Uganda and World Bank on the 19th January, 2017 and was declared effective for implementation on 26th May,2OL7.

Below is the break - down of the Components and an update on implementation, to date.

1) Results Based Financing (RBF) The Project is supporting government efforts to roll out RBF as a financing mechanism for Maternaland Child health to SL districts guided by the National RBF Framework adapted from our Health financing Strategy (2015).
To date we have started implementing RBF in 28 districts.

Health workers and local leaders were trained, health facilities were selected, RBF implementing agreements signed and approximately UGX 2.9 billion has been paid in "Start-up" grants to 232 health facilities and 28 Local governments.

My Ministry is now training health workers and leaders in the remaining 5L districts.

Starting July, 2019, we shall be paying approximately UGX 7.0 billion every Quarter for verified out-puts (Quality and Quantity).
2) Health Systems Strengthening (HSS) The project is supporting: training of health workers in RMNCAH displines, procurement of RMNCAH medicines & commodities, renovation of health facilities and improving quality of care.

ln FY 2018/19, Government (GoU) will renovate 82 Health Centre llls to fully functionalize the maternity wing, laboratories, waste management, access to safe water and patient waiting shelters and to provide staff accommodation for critical staff.
Construction will start in August, 201,9 for a period of L8 months.

Commodities: National medical stores (NMS) has completed evaluation of bids for supply of Reproductive health medicines and commodities, to cover supplies for the next 3 years to the entire country.

Part ofthe funds has been used to procure blood reagents for Uganda Blood Transfusion Services (UBTS).
We are using resources under this project to support maternal perinatal death surveillance and response (MPDSR), Health facility quality assessment project(s) - HFQAP and supervision of health care delivery.

The Ministry of health has awarded scholarships to 720 health workers between FY:2Q77 /LB and FY: 2OL8/tg at a total cost of UGX 8.9 billion.
The Ministry through the project has supported public Universities to start: the Bachelor of Aneasthesia (Busitema University), Diploma & Masters in Emergency Medicine (Mbarara and Makerere Universities) and a Fellowship programme in Neonatology at Makerere University.

3) Strengthen capacity to scale up Delivery of Birth and death Registration services amounting to USD 10 million.
The objective of this component is to strengthen institutional capacity for civil registration of vital statistics (CRVS) and scale up birth and Death Registration (BDR) services.

This function is however under the mandate of the National ldentification and Registration Authority (NIRA).

The URMCHIP project has supplied NIRA office equipment to Establish BDR offices in 122 districts that include Computer - desk tops and Servers.
The project has procured two mobile trucks to support NIRA to conduct Cou ntry - wide outreaches for BDR up to Sub county level.

The Ministry is finalizing the process of procurement of Firms to help NIRA develop a communication strategy for Civil Registration and vital statistics.

B. lnter-governmental Financing Transfer (IGFT) Using a Loan from the World Bank, the Ministry of health will upgrade 124 HC lls to HC llls in 100 Local governments.
Based on evidence that a big proportion of deliveries 139.3%l take place at HC lll, government has identified all sub counties in the country that have HC lls as the highest service Unit for upgrading to HC llls in a phased manner.

This will involve creation of a maternity ward, staff accommodation for especia lly midwives.

C) Uganda Health Systems Strengthening Proiect (UHSSP) Between 2077-2076, Government funded RMNCAH through the UHSSP.
This project supported commodities, Training and lnfrastructure development' Rt.

Hon Speaker, the table below shows UHSSP Expenditure Breakdown Com ponent 1.

Health lnfrastructure Comp 2.

Human Resource Development & Management 3.

Reproductive Health Comp 4.

Leadership and Management 5.


Project Management Comp Total Budget 83,881,883 4,L68,714 30,000,000 3,569,360 8,380,043 130,000,000 Government constructed 10 theaters and L5 maternity wards with providing water supply of 40,000 litre- capacity Reservoirs for 26 health centre fours (HC lVs) under the UHSSP.
Those include Aboke, Aduku, Atiak, Budaka, Budondo, Buvuma, Buyinja, Kabuyanda, Kasanda, Kibuku, Kiganda, Kikamulo, Kyantungo, Mwera, Mwizi, Nankoma, Ngoma, Ntenjeru- Kojja, Obongi HC lVs, Under the same loan (UHSSP), 916 health workers were trained in various Medical courses including Obstetrics & Gynaecology, Peadiatrics and Aneasthesia.
From the same Loan, Ministry of Health completed rehabilitation and equipping of nine (9) hospitals: Mityana, Nakaseke, Kiryandongo, Entebbe Grade B, Nebbi, Anaka, lganga, Moyo and Moroto.

ln addition, all the mentioned hospitals (individually) received an increase in their annual budgets: PHC wage - ucx 150 million to cater for wages of specialists, PHC non-wage - ucx 135 million to cater for operational costs and ucx 135 million for essential Medicines and health supplies.
Since FY:2017/18 Government has incrementally contributed funds to the Uganda Blood Transfusion Services (UBTS) to address issues of blood availability in the Country.

Bridging the Financial Gap The financial gap may be bridged through some of these identified channels: 1) lncrease domestic Financing, 2) lncrease in the efficiency and effectiveness.

3) Externa I Resource mobilisation.

4) lncreased partnership with the Private sector.

IN CONCLUSION; Rt.

Hon.


Speaker, All the above investments are aimed at improving the quality of care at all levels of services delivery with special focus on Maternal, Child and Neonatal health.

Thank you, I Hon.

Dr. MINISTER FOR HEALTH ng Ja ne Ruth FOR GOD AND MY COUNTRY a a Regional Referral Hospitals have also prioritized procurement of new ambulances to support the ever growing need of ambulance transportation and referral services arlsing out of the high toll of accidents.
Under the MKCCCAP project supported by the African Development Bank, Ministry of Health procured 10 ambulances to support emergency and referralservices in Kampala metropolitan area (Kampala, Waklso, Mpigi and Mukono).

3 of the ambulances were taken to Kyotera, Namutumba Districts and Njeru Municipality due to increasing demand for emergency care services.
r The Ministry of Health is working with the Uganda Police Forces, Uganda Red Cross Society and St lohn's Ambulance to establish lay first responders whose main role is to respond to emergencies and give first aid to the victims before being transported to hospital.
r Currently Minlstry of Health has plans to train community first responders as part of the process of establishing an Emergency Care System at Masaka Regional Referral Hospital covering 9 Districts with support from the Korean Government through the Korean Foundation for lnternational Health (KOFTH).
Despite the above interventions, Ministry of Health acknowledges that there are still gaps in the response to emergencies in the country specifically due to lack of trained first responders at the scene of accident, lack of a coordinated ambulance response, lack of a call and dispatch system, inadequate emergency medical response teams and unsatisfactory health facility emergency response' ln order to respond to the above challenges, Ministry of Heath; 1.
Has developed the Emergency Medicalservice Policy, EMS strategic plan and Ambulance gu ide lines to guide the expa nsion of these services in the country as it is elsewhere in the developed systems.

2.

Once the policy is approved by Cabinet, Ministry of Health will establish EMS coordination centres in the 14 health regions in the country taking into consideration hard to reach areas like Mountains and lslands.

5 3.
5 3.

Procure additional land ambulances and water ambulances to enhance the existing referrals system in the Country.

4.

Set up a National Call and dispatch centre supported by regional call and dispatch centres.

5.

Will request parliament to appropriate funding for the implementation of the costed Emergency Care Policy for Uganda 6.

Work with the Police and UPDF to provide aeromedical ambulance rescue and Maritime se rvices Thank you, Rt.

Hon.

Speaker, Hon.
Hon.

Speaker, Hon.

Dr. Jane Rut h Aceng Minister of Health FOR GOD AND MY COUNTRY 6