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First-Ever Harmonized Health Facility Assessment by MakSPH and MoH Reveals Improvements in Uganda’s Overall Health Services

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By Julius Tukacungurwa & Davidson Ndyabahika

The first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by MakSPH and the Ministry of Health (MoH) has illuminated significant advancements in Uganda’s healthcare landscape. This ground-breaking survey, which serves as a robust benchmark for evaluating health services across the country, offers a comprehensive overview of service availability and readiness within Ugandan health facilities. 

The HHFA, a successor to the esteemed Service Availability and Readiness Assessment (SARA) tool endorsed by the WHO, probes into four critical modules: service availability, service readiness, quality of care and safety, and management and finance. 

Focusing initially on service availability and readiness, the HHFA embarked on a cross-sectional analysis of 642 facilities in April 2022, spanning National Referral Hospitals (NRHs), Regional Referral Hospitals (RRHs), General Hospitals (GHs), primary healthcare facilities at levels II, III, and IV.

The findings, while highlighting disparities in service availability and facility capacity across different healthcare sectors, underscore a promising trajectory towards enhancing overall health services nationwide.

Dr. Christopher Garimoi Orach, a Professor of Community Health at Makerere University School of Public Health (MakSPH), led the team that conducted the survey. He presented the report which was subsequently launched by Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero on Tuesday 12th.March.2024 during the 10th Annual National Health Care Quality Improvement Conference at Imperial Resort Beach Hotel, Entebbe.

Dr. Christopher Garimoi Orach, a Professor of Community Health at Makerere University School of Public Health (MakSPH) speaks to the press during the launch of the report in Entebbe. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.
Dr. Christopher Garimoi Orach, a Professor of Community Health at Makerere University School of Public Health (MakSPH) speaks to the press during the launch of the report in Entebbe.

The findings of the HHFA report indicate that Reproductive Maternal Newborn Care and Adolescent Health (RMNACH) services were available in most health care facilities across the country. In Uganda, healthcare facilities offer a wide range of essential services, including pediatric care, antenatal and postnatal care, malaria prevention during pregnancy, and newborn care, with over 95% providing these services according to the report. Findings also show that continuous antenatal care is available in about 79% of facilities, while skilled delivery services are offered in 89%. Additionally, family planning, emergency obstetric care, immunization, and adolescent health services are widely accessible, with percentages ranging from 77% to 91%.

During the launch event, Dr. Aceng underscored the significant steps made by the health sector in meeting crucial performance benchmarks. These include a notable 47% reduction in Maternal Mortality between 2016 and 2022, a commendable 12% decrease in Under 5 Mortality over the same period, and a promising 7% decline in Infant Mortality rates as highlighted in the Uganda Demographic Survey (UDHS) Report 2022.

“As you might know, overall, the health sector has made good progress towards achieving the key performance indicator targets. I wish to appreciate each one of you for the job well done,” said Dr. Aceng. 

Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero speaks at the launch on March 12, 2024. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.
Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero speaks at the launch on March 12, 2024.

Adding that; “The Ministry of Health continues to make big investments in the national health system. Mulago National Referral Hospital, Mulago Specialised Women and Neonatal Hospital, and several Regional Referral Hospitals have received infrastructure development including installation of modern medical equipment.

There is also deliberate effort to improve access to health service, delivery to the community through purposeful upgrade of some HC IIs to corresponding equipping and general review of the human resource requirements in the health sector. There is also deliberate effort to improve access to health services, delivery to the community through purposeful upgrade of some HC lIs to HC Ills with corresponding equipping and general review of the human resource requirements in the health sector.”

Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero signs off the launch of the Harmonized Health Facility Assessment in Uganda Report, 2023. Looking on is Professor Garimoi Orach Christopher. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.
Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero signs off the launch of the Harmonized Health Facility Assessment in Uganda Report, 2023. Looking on is Professor Garimoi Orach Christopher.

The also study highlights a significant increase in Uganda’s general service index, rising from 48% in 2018 to 59% presently. Utilizing a similar survey methodology, researchers observed notable improvements in the availability of health interventions across various domains. Particularly in Reproductive Maternal Adolescent Health services, higher provision rates were evident, especially at higher-level health facilities. Moreover, delivery assistance at Health Centres IIIs and above by skilled attendants has become standard practice, with nine out of ten cases receiving skilled care. 

Immunization services have also witnessed widespread availability, notably in hospital settings. However, while all surveyed facilities now offer malaria treatment services, access to non-communicable disease management, such as cancer diagnosis and treatment, remains limited, and readiness to provide transportation services for community members in need is inadequate.

According to Professor Orach, the Ministry of Health should strengthen and improve diagnosis and treatment of cancers generally across the country, especially at the National and Regional Referral Hospitals so that many more people at community levels can access the services. He also notes that the Ministry needs to quickly do everything possible to strengthen the transportation systems for patients from communities to reach and access health services.

Professor Orach presenting findings of the Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero signs off the launch of the Harmonized Health Facility Assessment in Uganda Report, 2023. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.
Professor Orach presenting findings of the Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero signs off the launch of the Harmonized Health Facility Assessment in Uganda Report, 2023.

The research noted that salary enhancement is a step in the right direction for improving how health workers perform. “We need to enhance that by ensuring that, ‘the health system, which is a complex system’, when we enhance salaries, we still need to continue to monitoring the health workers, we still need to continue to provide other requirements for the performance of health services, like drugs should be available,” noted Professor Orach. 

Adding that; “Transport should be available, other ways of ensuring that their performance can be up to the expected standard. So, in other words, that’s an important step and we must thank the government for what they’ve done here for we should still support them in other ways and monitor them closely to ensure, guidelines are available for services, that drugs are available, so that they can continue to provide good services.” 

“Our findings also show that for instance, the private health practitioners are not carrying out a lot of immunization, but government health facilities and private not for profit facilities are providing immunization services. This means that the private health practitioners don’t focus on immunization since it may not be bringing them money, they sought the ministry to engage with them to ensure that they’re brought on board so that they can provide their services in an integrated manner,” he noted. 

During the event, Associate Professor Peter Waiswa from the Health Policy, Planning and Management Department at MakSPH delivered a keynote address on ‘Understanding Health Systems Strengthening in a resource limited set-up.’  Professor Waiswa has had research work in maternal, new-born and child health in low and middle-income countries.

Stakeholders during the launch of the report in a group photo. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.
Stakeholders during the launch of the report in a group photo. 

According to Dr. Diana Atwiine, the Permanent Secretary of the Ministry of Health, this health facility assessment and report will significantly enhance MoH’s institutional capacity for strategic planning and policy development in Uganda’s health sector.

“The Makerere University School of Public Health (MakSPH) Team led by Prof. Christopher Garimoi Orach is appreciated for spearheading the entire process of undertaking the HHFA and developing the report. The MoH is very grateful for the diligent work well-done by the various actors that included the technical officers, research assistants and the administration staff to have the final report meticulously developed,” said Dr. Atwiine. 

Dr. Henry G. Mwebesa, Director General of Health Services, emphasizes the pivotal role of robust health systems in achieving lasting health advancements. He underscores that the findings will facilitate the country’s ability to track health service progress, advancing towards Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs). This data supports evidence-based decision-making, fortifying national health system planning and policy-making.

“This HHFA report is recommended for use by the various key stakeholders including health service managers, district leaders, ministry of health officials, both government, private sector, civil society organizations and development partners at different levels to inform and improve planning and implementation of effective health services delivery in Uganda,” says Dr. Mwebesa. 

Photos by Julius Tukacungurwa.

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METS Newsletter March 2024

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A team documenting the background and other governance structure requirements in the EMR Implementation Guidelines during the stakeholder workshop held from 26th February to 1st March 2024. Makerere University School of Public Health (MakSPH), METS Program, Kampala Uganda, East Africa.

The Monitoring and Evaluation Technical Support (METS) Program is a 5-year CDC-supported collaboration of Makerere University School of Public Health (MakSPH), the University of California San Francisco (UCSF) and Health Information Systems Program (HISP Uganda).

Highlights of the METS March 2024 Newsletter

  • Development of National Electronic Medical Records (EMR) Implementation Guidelines
    • To date, multiple Electronic Medical Records (EMR) systems have been rolled out to health facilities without implementation guidelines to inform the standard EMR process/clinical workflows within a typical health facility, minimum requirements for various EMRs to integrate and exchange patient information, insurance and billing workflows, human resources management, among others.
    • METS Program and USAID/SITES organized a five-day stakeholder workshop on 26th February to 1st March 2024, to develop and validate the EMR Implementation Guidelines for Uganda.
  • Improving the Quality of Voluntary Medical Male Circumcision
    • In February 2024, the METS Program, in collaboration with the Ministry of Health (MoH), Centers for Disease Control and Prevention (CDC), and Implementing Partners (IMs), conducted targeted onsite mentorship across 56 safe male circumcision sites in CDC-supported regions of Uganda.
    • Key findings highlighted the overall facility performance score of 78%, with 5 out of 8 thematic areas scoring above 80%. Notably, 99% of circumcised males had received Tetanus vaccines.
  • Innovation To Strengthen National Health Care Quality Improvement
    • The 10th National Health Care Quality Improvement (QI) conference brought together health service providers from various parts of the country to share experiences and what they are doing to improve service delivery to patients.
    • The Minister of Health, Hon. Dr. Jane Ruth Aceng, called for solutions that will provide answers especially in areas of governance and leadership, health workforce, information systems, service delivery, financing, special groups, and health products.
    • METS made a presentation on improved service delivery models focusing on empowering young women to stay HIV-free with the help of the Determined Resilient Empowered AIDS-free Mentored and Safe (DREAMS) initiative.
  • Gallery
    • Makerere University School of Public Health (MakSPH) launches state-of-the-art auditorium
    • Deploying latest EMR Version at Hoima RRH
    • Training of KCCA staff on use of Point of Care (POC) EMR
    • Stakeholder Workshop on Development of EMR Implementation Guidelines

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New Study Reveals Breastfeeding Mothers Embrace Nutrient-Rich Dish for Health Benefits

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Climbing beans on stakes in one of the gardens visited during the Efd-Mak Kabale District Sensitization in November 2021. Makerere University, Kampala Uganda, East Africa.

A study whose results were recently published in Food Science Nutrition, a peer-reviewed journal for rapid dissemination of research in all areas of food science and nutrition has revealed that there is a growing preference for wholesome meals, highlighting its numerous health benefits.

Titled; Lactating mothers’ perceptions and sensory acceptability of a provitamin A carotenoid–iron-rich composite dish prepared from iron-biofortified common bean and orange-fleshed sweet potato in rural western Uganda,” this study was conducted among pregnant and breastfeeding mothers seeking care at Bwera General Hospital, in Kasese district, western Uganda, between 4th and 15th of August 2023.

Researchers in a 2019 study published in BMC Pregnancy and Childbirth among pregnant and breastfeeding women in Northwest Ethiopia discovered that pregnant and breastfeeding women bear the highest burden of this deficiency due to heightened physiological demands for iron and vitamin A. These demands increase significantly during pregnancy to meet fetal needs and continue during lactation to support breastfeeding.

The 2020 report on Developments in Nutrition among 204 countries and territories for 30 years since 1990 highlights the substantial impact of dietary iron deficiency and vitamin A deficiency on women of reproductive age in low- and middle-income countries across Africa and Asia. These micronutrient deficiencies are of paramount concern in public health nutrition due to their adverse effects.

A 2022 study published in The Lancet Global Health reveals that progress in addressing anemia among women of reproductive age (15–49 years) is inadequate to achieve the World Health Assembly’s global nutrition target of reducing anemia prevalence by 50% by 2030 in low- and middle-income countries, including Uganda.

Breastfeeding mothers require a higher intake of iron, ranging from 10–30 mg/day, compared to 8 mg/day for adult males. To help meet this increased need, the World Health Organization (WHO) recommends iron supplementation programs during the postpartum period, starting immediately after delivery and continuing for the first 6 weeks.

On the other hand, the WHO advises against vitamin A supplementation during the postpartum period, as it offers no noticeable health benefits to either the mother or the infant. Instead, it encourages breastfeeding mothers to maintain a diversified diet that includes vitamin A-rich foods. However, it’s important to highlight that supplementing with vitamin A and iron during this time could enhance the content of these nutrients in breast milk.

In rural Uganda, breastfeeding mothers often face deficiencies in vital nutrients particularly vitamin A and iron. This is as a result of over reliance on plant-based local foods, like sweet potato and non-iron biofortified common bean like Nambale, which lack sufficient amounts of provitamin A and iron, respectively.

To improve vitamin A and iron intake among breastfeeding mothers, Uganda’s government, in collaboration with HarvestPlus, a global program dedicated to ending hunger through providing nutrient-rich foods launched biofortification programs. These initiatives introduced orange-fleshed sweet potato rich in provitamin A and iron-biofortified common bean as staple food in Uganda.

As part of his postdoctoral study, Dr. Edward Buzigi, a Nutritionist and Food security expert, at University of Kwa-Zulu Natal, South Africa, evaluated the perceptions and sensory acceptability of a dish made from a combination of orange-fleshed sweet potato and iron-biofortified common bean, known for their high levels of provitamin A carotenoids and iron.

The aim was to determine whether the test food could replace the traditional white-fleshed sweet potato and non-iron biofortified common beans, which lacks these essential nutrients.

Ninety-four breastfeeding mothers took part in the study comparing two foods. Participants assessed the taste, color, aroma, texture, and overall acceptability of both the test and control foods using a five-point scale. Ratings ranged from “dislike very much” to “like very much,” with attributes deemed acceptable if participants rated them as “like” or “like very much.”

Also, focus group discussions were held to explore participants’ thoughts on future consumption of the test food alongside statistical analysis done using the chi-square test to compare sensory attributes between the two food options, while the qualitative data from focus group discussions were analyzed using thematic analysis.

Findings revealed that taste, color, and aroma were satisfactory to the mothers and showed no significant difference between test food and control food. Mothers had favorable views of the taste, aroma, and color of orange-fleshed sweet potato and iron-biofortified common bean but expressed concerns about the soft texture of orange-fleshed sweet potato. Despite this, breastfeeding mothers expressed positive attitudes towards consuming orange-fleshed sweet potato and iron-biofortified common bean, as long as it was accessible, affordable, and easy to prepare.

Dr. Buzigi lecturers at the Department of Community Health and Behavioural Sciences at Makerere University School of Public Health in Uganda.

Read the scientific article here;  https://onlinelibrary.wiley.com/doi/full/10.1002/fsn3.4053

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Call for Applications: AWE Change Masters fellowship programme support

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L-R: The Departments of Family Medicine (School of Medicine) and Human Anatomy (School of Biomedical Sciences) Buildings, College of Health Sciences (CHS), Mulago Hill, Makerere University, Kampala Uganda, East Africa.

Makerere University College of Health Sciences in collaboration with Duke University, USA are conducting a national collaborative research study on Epilepsy with local leading researchers in the fields of neurology and psychology in Uganda and international experts in the field of neurology and neurosurgery in the USA. The study aims to investigate the panorama of epilepsy in Uganda across the life span by clinically characterizing its features, comorbidities, and risk factors among the general population, with a focus on stigma among adolescents.

Applications are invited for the AWE Change Masters fellowship programme support from postgraduate students of:

  • Makerere University College of Health Sciences
  • Mbarara University of Science and Technology
  • Gulu University

The closing date for the receipt of applications is 22nd May 2024.

Submit all Enquiries and Applications to awechangeproject@gmail.com

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