Uganda Protestant Medical Bureau
Contribution of UPMB in Ending Extreme poverty
Dr. Tonny Tumwesigye
Executive Director
CCIH Annual Conference 26th – 29th June 2015
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Background
• Founded in 1957 by government notice no. 672
• National umbrella organization for Protestant,Adventist and Pentecostal Founded member healthfacilities.
• 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 networksin Uganda (UCMB, UMMB, UOMB)
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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“
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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
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Facilities across Uganda-(DHIS2 – GIS
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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
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Historical feature of Uganda’s health system
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Contribute to all health system building blocks and levels of care
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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
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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
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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 ? ? ?
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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
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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
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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
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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
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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 Antiretroviral therapy
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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
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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
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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
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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
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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
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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
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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
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Major challenges• High staff turnover rate
– Most departures are destined to government (60 –70%)
– Some to Vertical Projects, mainly in HIV/AIDS
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• 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
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• 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
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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
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THANK YOU