Uganda’s increasing dependence on development partner’s support for immunization – a five year resource tracking study (2012 – 2016)

Abstract Background In Uganda, there are persistent weaknesses in obtaining accurate, reliable and complete data on local and external investments in immunization to guide planning, financing, and resource mobilization. This study aimed to measure and describe the financial envelope for immunization from 2012 to 2016 and analyze expenditures at sub-national level. Methods The Systems of Health Accounts (SHA) 2011 methodology was used to quantify and map the resource envelope for immunization. Data was collected at national and sub-national levels from public and external sources of immunization. Data were coded, categorized and disaggregated by expenditure on immunization activities using the SHA 2011. Results Over the five-year period, funding for immunization increased fourfold from US$20.4 million in 2012 to US$ 85.6 million in 2016. The Ugandan government was the main contributor (55%) to immunization resources from 2012 to 2014 however, Gavi, the Vaccine Alliance contributed the majority (59%) of the resources to immunization in 2015 and 2016. Majority (66%) of the funds were managed by the National Medical Stores. Over the five-year period, 80% of the funds allocated to immunization activities were spent on facility based routine immunization (expenditure on human resources and outreaches). At sub-national level, districts allocated 15% of their total annual resources to immunization to support supervision of lower health facilities and distribution of vaccines. Health facilities spent 5.5% of their total annual resources on immunization to support outreaches. Conclusion Development partner support has aided the improvement of vaccine coverage and increased access to vaccines however, there is an increasing dependence on this support for a critical national program raising sustainability concerns alongside other challenges like being off-budget and unpredictable. To ensure financial sustainability, there is need to operationalize the immunization fund, advocate and mobilize additional resources for immunization from the Government of Uganda and the private sector, increase the reliability of resources for immunization as well as leverage on health financing reforms like the National Health Insurance.

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Uganda’s Increasing Dependence On Development Partner’s Support For Immunization – A Five Year Resource Tracking Study (2012 – 2016)

10.21203/rs.3.rs-17585/v2 ◽

2020 ◽

Author(s):

Carol Kamya ◽

Christabel Abewe ◽

Peter Waiswa ◽

Gilbert Asiimwe ◽

Faith Namugaya ◽

...

Keyword(s):

Vaccine Coverage ◽

National Level ◽

Health Financing ◽

Health Centers ◽

Development Partner ◽

National Medical ◽

External Sources ◽

Lower Health ◽

Health Accounts ◽

The Government

Abstract Background: In Uganda, there are persistent weaknesses in obtaining accurate, reliable and complete data on local and external investments in immunization to guide planning, financing, and resource mobilization. This study aimed to measure and describe the financial envelope for immunization from 2012 to 2016 and analyze expenditures at sub-national level.Methods: The Systems of Health Accounts (SHA) 2011 methodology was used to quantify and map the resource envelope for immunization. Data was collected at national and sub-national level from public and external sources of immunization through key informant interviews coupled with document reviews. Data were coded using the SHA, categorized and disaggregated to detail the expenditure on immunization activities. Results: Over a five-year period, funding for immunization increased fourfold to US$ 85.6 million in 2016. The Ugandan government was the main contributor (55%) to immunization resources from 2012 to 2014. However, Gavi, the Vaccine Alliance contributed the majority (59%) of the resources to immunization in 2015 and 2016. Majority (66%) of the funds were managed by the National Medical Stores. Over the five-year period, 80% of the funds allocated to immunization activities were spent on facility based routine immunization (expenditure on human resources and outreaches). At sub-national level, districts allocated 15% of their total annual resources to immunization to support supervision to lower health centers (including distribution of vaccines). Health facilities spent 5.5% of their total annual resources on immunization to support outreaches.Conclusion: Development partner support has aided the improvement of vaccine coverage and increased access to vaccines. However, there is an increasing dependence on this support for a critical national program raising sustainability concerns alongside other challenges like being off budget and unpredictable. To ensure financial sustainability, there is need to operationalize the immunization fund, advocate and mobilize additional resources for immunization from the Government of Uganda and the private sector, increase the reliability of resources for immunization as well as leverage on health financing reforms like the National Health Insurance.

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Uganda’s Increasing Dependence On Development Partner Support For Immunization – A Five Year Resource Tracking Study (2012 – 2016)

10.21203/rs.3.rs-17585/v1 ◽

2020 ◽

Author(s):

Carol Kamya ◽

Christabel Abewe ◽

Peter Waiswa ◽

Gilbert Asiimwe ◽

Faith Namugaya ◽

...

Keyword(s):

District Level ◽

Partner Support ◽

Routine Immunization ◽

Vaccine Introduction ◽

Development Partner ◽

National Medical ◽

Resource Needs ◽

External Sources ◽

Lower Health ◽

Health Accounts

Abstract Background There are persistent weaknesses in obtaining accurate reliable and complete data on local and external investments in immunization and yet these are critical to estimate costs, resource needs and gaps so as to aid country financing, planning and resource mobilization. This study aimed to measure and describe the financial envelope for immunization activities and conduct an expenditure analysis at district level. Methods The Systems of Health Accounts (SHA) 2011 methodology was used to quantify and map out the resource envelope for immunization. Data were collected at national and district levels from public and external sources of immunization through key informant interviews coupled with document reviews. Data were coded (SHA), categorized and disaggregated to allow for greater detail on the types of immunization activities. Financing methodology used was largely drawn from Guthrie et al, 2015. Results Over a five-year period, funding for immunization has increased fourfold from US$20.4 million in 2012 to US$ 85.6 million in 2016. The increase in the resource envelope is attributed to the lift of the ban of Gavi funding to Uganda as well as new vaccine introduction. Gavi, the Vaccine Alliance became the biggest contributor (59%) in 2015 and 2016 with 66% of the funds managed by National Medical Stores. Eighty percent of the resources are spent on facility-based routine immunization which includes expenditure on human resources and immunization outreaches. At district level, the overall proportion of total funding to immunization was 15% of their Primary Health Care (PHC) Grant. The bulk (82%) of the PHC funds were spent on supervision to lower health centers (transport and distribution of vaccines) while majority (51%) development partner funds were spent on routine immunization activities (vaccine collection and per-diems/allowances to support outreaches). Conclusion The increasing dependence on development partner support raises issues around sustainability alongside other challenges like misalignment and displacement This warrants an increase in financial commitment to immunization by Government of Uganda, prioritization of resources for immunization at district level, and also operationalization of the existing financial sustainability plan for immunization.

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Analysis of the Economic Burden of Noncommunicable Diseases in Dalian City of China, Based on the “System of Health Accounts 2011”

10.21203/rs.3.rs-223078/v1 ◽

2021 ◽

Author(s):

Quan Fang ◽

Shunli Zhang ◽

Shuang Zang ◽

Huan Zhan ◽

Boxi Liu ◽

...

Keyword(s):

Economic Burden ◽

Family Health ◽

Health Financing ◽

Policy Formulation ◽

Noncommunicable Diseases ◽

Factors Affecting ◽

Multi Stage ◽

Health Accounts ◽

The Government ◽

System Of Health Accounts

Abstract Objectives: Noncommunicable diseases (NCDs) are the leading causes of morbidity and mortality worldwide. Understanding the distribution of diseases can provide a basis for policy formulation and intervention. This study analyses the status of the NCDs spending based on “System of Health Accounts 2011” (SHA 2011), to provide health policy advice to China, and give guidance for other areas in the world.Methods: Data were collected by multi-stage stratified random sampling in 2018. The medical expenses of patients with NCDs were calculated based on SHA 2011, Analyze from funding sources, dimensions of institutional flow, and financing scheme. The factors influencing the cost of hospitalization were analyzed by linear regression. All analyses were conducted by software SPSS 25.0 and STATA 15.0.Results: A total of 392 institutions and 2,478,359 valid items were included for study. The current curative expenditure (CCE) of NCDs was 15.914 billion CNY. 61.78% of NCDs financing came from public financing scheme. The proportion of family health financing (32.56%) was higher. The expenditures were mainly in general hospitals (74.95%). Elderly patients account for the majority (76.35%). Drug expenses, length of stay, and institution level were the major factors affecting hospitalization expenses.Conclusions: NCDs are the main economic burden of diseases in Dalian, and its resources are not allocated reasonably. To reduce the economic burden of NCDs, the government needs to optimize resource allocation, and rationalize institutional flows and functions.

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Family planning financing: tracking domestic family planning budget allocations at national and sub-national level in Kenya and Uganda

Gates Open Research ◽

10.12688/gatesopenres.12995.1 ◽

2019 ◽

Vol 3 ◽

pp. 1723 ◽

Cited By ~ 1

Author(s):

Joshua Ongwae

Keyword(s):

Family Planning ◽

National Level ◽

Health Sector ◽

Fiscal Year ◽

African Union ◽

National Medical ◽

Budget Analysis ◽

The Government ◽

Financial Allocation ◽

Health Commodities

Background: The Abuja Declaration committed African Union countries to allocate at least 15% of their budget to improving the health sector. Consequently, Deutsche Stiftung Weltbevoelkerung (DSW) has been undertaking annual budget studies in Kenya and Uganda to track financial allocation for health and family planning (FP). Methods: This study, carried out between the months of May and October 2017, involved budget analysis of general health and FP funding at national and sub-national level. The study covered the fiscal year 2017/18. However, for comparison purposes, fiscal years 2015/16 and 2016/17 were included in the analysis. Results: In Uganda, during the 2017/18 fiscal year, the government allocated 0.73% ($3.7 million) of its health sector budget ($506.7 million) to FP; of which 98.8% ($3.6 million) was allocated to National Medical Stores (NMS), mainly for the supply of reproductive health commodities. Analysis of four districts shows that only 0.5% ($7,966), 0.8% ($10,046), 0.9% ($9,663) and 1.9% ($35,395) of the health sector budget was allocated to FP in Kamuli, Mityana, Mukono and Tororo, respectively, during the 2017/18 fiscal year. In Kenya, the FP budget allocation at the national level reduced from $6.05 million in 2015/16 to $2.93 million in 2017/18. At the subnational level, there were combined increases in the estimated sub-national FP budget allocations in all eleven counties of 21.8% ($2.1 million), from $9.6 million (2016/17) to $11.7 million (2017/2018). Conclusions: The findings indicate an overall increase in FP allocations over the last three years in the two countries of study. Advocacy personnel should be enlightened on the budget making process, as it provides an excellent platform for advocating for budgetary increases.

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Evidence Based Health Demographic Assessment of URIRI Sub-County in Migori County, Kenya

Journal of Current Medical Research and Opinion ◽

10.15520/jcmro.v3i08.325 ◽

2020 ◽

Vol 3 (08) ◽

Author(s):

Njeru S. Kagoiyo ◽

Mburu S. Wanjiku ◽

Sabinah W. Kagoiyo

Keyword(s):

National Level ◽

Family Care ◽

Health Resources ◽

Relevant Information ◽

Health Facilities ◽

Maternal Child Health ◽

Low Literacy ◽

The Government ◽

Study Participants ◽

Study Setting

Objective: To assess health demographic profile of Uriri sub-County in Migori county, Kenya. Study Design: Prospective study using a questionnaire Study Setting: Uriri Sub-County in Migori County, Kenya Study Participants/Subjects: Mothers with children under the age of five years. This was done purposely in order to capture the relevant information required on maternal, child health and other areas. Results: The survey revealed many gaps that needed interventions both locally and from the National level. The literacy levels were still wanting with 70% not going past tertiary levels of education. This had an impact on diverse areas socio-economically starting with family life with children occupying 56% of the total house hold composition. This led to low literacy levels. The finding also revealed poor food security situation in Uriri constituency, with over 70% admitting they did not have enough food stocks in their households to last them till the next harvest. Three hundred and forty one (50.3%) mothers did not deliver in the available health facilities and 40.7% did not attend Antenatal Clinics. Conclusion: Literacy especially amongst women is quite important in the making of a community, even though both sexes play an important part in passing education down their generations. Lack of education and information on pertinent issues of family care led to increased numbers of children which directly impacted on the overall population. Lack of financial capacity and economic empowerment was part of the reason for food insecurity in the area. The study showed that half of the women in Migori County do not visit the health facilities available in the county. This is in spite of the Government providing health resources in the region.

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Health Coverage and Financial Protection in Uganda: A Political Economy Perspective

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2021.116 ◽

2021 ◽

Author(s):

Maria Nannini ◽

Mario Biggeri ◽

Giovanni Putoto

Keyword(s):

Political Economy ◽

Universal Health Coverage ◽

National Level ◽

Health Financing ◽

Negotiation Process ◽

Financial Protection ◽

Health Coverage ◽

Financing System ◽

The Government ◽

Universal Health

Background: As countries health financing policies supporting progress towards Universal Health Coverage (UHC), an analysis of these policies is particularly relevant in Low and Middle-Income Countries (LMICs). In 2001, the government of Uganda abolished user-fees to improve accessibility to health services for the population. However, after almost 20 years, the incidence of catastrophic health expenditures is still very high, and the health financing system does not provide a pooled prepayment scheme at national level such as an integrated health insurance scheme. Objective: This article aims at analysing the Ugandan experience of health financing reforms with a specific focus on financial protection. Financial protection represents a key pillar of UHC and has been central to health systems reforms even before the launch of the UHC definition. Methods: The qualitative study adopts a political economy perspective and it is based on a desk review of relevant documents and a multi-level stakeholder analysis based on 60 Key Informant Interviews in the health sector. Results: We find that the current political situation is not yet conducive for implementing a universal health coverage system with widespread financial protection: dominant interests and ideologies do not create a net incentive to implement a comprehensive scheme for this purpose. The health financing landscape remains extremely fragmented, and community-based initiatives to improve health coverage are not supported by a clear government stewardship. Conclusion: By examining the negotiation process for health financing reforms through a political economy perspective, this article intends to advance the debate about politically-tenable strategies for achieving UHC and widespread financial protection for the population in LMICs.

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Tata kelola internal dan eksternal untuk mengatasi permasalahan pangan di Indonesia

Jurnal Good Governance ◽

10.32834/gg.v13i1.26 ◽

2018 ◽

Vol 13 (1) ◽

Author(s):

Reza Hendriyantore

Keyword(s):

Good Governance ◽

National Level ◽

Open Government ◽

Agricultural Cooperatives ◽

Methodological Framework ◽

Agricultural Cooperative ◽

The Reformation ◽

The Government ◽

Good Access ◽

Descriptive Method

The effort to put good governance in development in Indonesia is basically not new. Since the Reformation, the transformation of closed government into an open government (inclusive) has begun to be pursued. Highlighting the conflicts in the land sector that tend to strengthen lately, there are some issues that have intensified conflicts in the field, such as the lack of guaranteed land rights in various legal and policy products. In this paper, a descriptive method is considered important in identifying the applicable issue and methodological framework for addressing governance issues in Indonesia. To reduce such agrarian conflicts between farmers and the government, and as an effort to increase farmers' income, all farmers are incorporated into agricultural cooperatives. Agricultural cooperatives are structured down to the National Level. Thus, farmers participate in good access to the marketing of agricultural produce.Keywords:good governance, agrarian conflict, agricultural cooperative

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Manajemen Sekolah Adiwiyata (Green School)

Jurnal Soshum Insentif ◽

10.36787/jsi.v3i1.214 ◽

2020 ◽

pp. 37-43

Author(s):

Asep Priatna

Keyword(s):

Junior High School ◽

National Level ◽

Educational Institutions ◽

School Program ◽

West Java ◽

World Community ◽

Strategic Issue ◽

Green School ◽

The Government ◽

Environmentally Sound

The issue of environmental pollution has come to the attention of the world community and has become a strategic issue in sustainable development, so it needs to have the support of all parties, including the government, the private sector and educational institutions. Integrated Junior High School Lampang, Subang Regency West Java Indonesia has been implementing the green school program since 2008 and in 2019 it was entrusted by the West Java Education Office to be proposed as a national level green school program. Some achievements as a green school implementing school are private schools that have obtained "A" (exellent) accreditation with a beautiful environment and are able to fulfil 4 (four) components, namely (1) environmentally sound policies, (2) implementation of environment-based curriculum, (3) participatory-based environmental activities and (4) management of environmentally friendly supporting facilities Keywords : Management, green school Isu pencemaran lingkungan hidup telah menjadi perhatian masyarakat dunia dan menjadi isu strategis dalam pembangunan berkelanjutan, sehingga perlu mendapat dukungan semua pihak baik pemerintah, sector swasta maupun lembaga pendidikan. SMPS Terpadu Lampang Kabupaten Subang telah melaksanakan program adiwiyata sejak tahun 2008 dan pada tahun 2019 diberi kepercayaan oleh Dinas Pandidikan Jawa Barat diusulkan sebagai Sekolah Adiwiyata (green school program) tingkat nasional. Beberapa capaian sebagai sekolah pelaksana green shcool adalah sekolah swasta yang telah memperoleh akreditasi “A” (Unggul) dengan lingkungan asri dan mampu memenuhi 4 (empat) komponen yaitu (1) kebijakan berwawasan lingkungan, (2) pelaksanaan kurikulum berbasis lingkungan, (3) kegiatan lingkungan berbasis partisipatif dan (4) pengelolaan sarana pendukung ramah lingkungan Kata Kunci : Manajemen, Sekolah Adiwiyata

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Protocol for establishing an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) for integrating care of communicable and non-communicable diseases using tuberculosis and diabetes as a case study

BMJ Open ◽

10.1136/bmjopen-2020-041521 ◽

2021 ◽

Vol 11 (4) ◽

pp. e041521

Author(s):

Stellah G Mpagama ◽

Kaushik Ramaiya ◽

Troels Lillebæk ◽

Blandina T Mmbaga ◽

Marion Sumari-de Boer ◽

...

Keyword(s):

Operational Research ◽

Communicable Diseases ◽

Health Facilities ◽

Learning System ◽

Management Approach ◽

African Countries ◽

Non Communicable Diseases ◽

Research Outcomes ◽

The Government

IntroductionMost sub-Saharan African countries endure a high burden of communicable infections but also face a rise of non-communicable diseases (NCDs). Interventions targeting particular epidemics are often executed within vertical programmes. We establish an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) model with three domains; stepwise training approach, integration of communicable and NCDs and a learning system. The model aims to shift traditional vertical programmes to an adaptive diseases management approach through integrating communicable and NCDs using the tuberculosis (TB) and diabetes mellitus (DM) dual epidemic as a case study. We aim to describe the ADEPT protocol with underpinned implementation and operational research on TB/DM.Methods and analysisThe model implement a collaborative TB and DM services protocol as endorsed by WHO in Tanzania. Evaluation of the process and outcomes will follow the logic framework. A mixed research design with both qualitative and quantitative approaches will be used in applied research action. Anticipated implementation research outcomes include at the health facilities level for organising TB/DM services, pathways of patients with TB/DM seeking care in different health facilities, factors in service delivery that need deimplementation and the ADEPT model implementation feasibility, acceptability and fidelity. Expected operational research outcomes include additional identified patients with dual TB/DM, the prevalence of comorbidities like hypertension in patients with TB/DM and final treatment outcomes of TB/DM including treatment-related complications. Findings will inform the future policies and practices for integrating communicable and NCDs services.Ethics and disseminationEthical approval was granted by The National Research Health Ethical Committee (Ref-No. NIMR/HQ/R.8a/Vol.IX/2988) and the implementation endorsed by the government authorities. Findings will be proactively disseminated through multiple mechanisms including peer-reviewed journals, and engagement with various stakeholders’ example in conferences and social media.

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Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative

BMJ Global Health ◽

10.1136/bmjgh-2021-005833 ◽

2021 ◽

Vol 6 (6) ◽

pp. e005833

Author(s):

Leena N Patel ◽

Samantha Kozikott ◽

Rodrigue Ilboudo ◽

Moreen Kamateeka ◽

Mohammed Lamorde ◽

...

Keyword(s):

Health Facility ◽

Healthcare Workers ◽

National Level ◽

Lessons Learned ◽

Health Facilities ◽

Infection Prevention And Control ◽

Health Facility Level ◽

Ensure Patient Safety ◽

Increased Risk ◽

Facility Level

Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.

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