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Health Management/ Quality Assurance (HM?QA)Achievements and Products | Activities
1. Drug Logistics Management Activities in this area were planned jointly with the counterpart districts and the Ministry of Health who implemented some of them in six other districts covered by the District Drug Management Program. Following the development of store management procedures, and the initial training of core logistics teams, the Project provided facilitation for on-site support of staff involved in logistics activities through regular support supervision or dedicated HMIS/ logistics visits. Planning/Management Coordinators was mostly involved in providing on-site TA and focused their support on the systematic use of stock management procedures (in particular updated stock cards). The Project supported training in drug needs quantification in coordination with National Drug Authorities for those districts where this training had not yet occurred. It also developed a practical application tool for the drug quantification methodology at HSD level, based on the NDA training curriculum. A Project-wide needs quantification exercise was conducted in January 2002 to provide district planners and HSD and facility managers an opportunity to apply the skills learned during the training. It also used a register-based methodology, looking at drug needs estimates as defined by the prescription patterns of the providers. The exercise will also enable managers to better and more rationally plan/budget drug procurement for the 2002-3 exercise, at a time where the supply of essential drug kits may be phased out definitively and replaced by a demand-drive "pull" system. Results of the exercise were also use to modify the composition of the current essential drug kit and of the future "default order" for lower level facilities according to actual demand. Comparison of standardised drug requirements per 1,000 OPD cases (register based) with the Essential Drugs KIT contents for the 7 most prescribed drugs
The Project worked on a regular basis with institutions involved in the procurement ad distribution of drugs and contraceptives, including the Reproductive Health Division/MOH, NMS, NDA, USAID and other donors, to improve forecasting of needs and follow-up of inputs into the drug pipeline. These activities involved:
As the initial assessment of Drug Logistics systems in the districts had shown problems in the physical conditions of storage, the component supported the refurbishment of nine district (or HSD) medical stores. After the initial survey for the definition of scopes of work and bills of quantities, three contractors conducted the refurbishment work, including installation of containers or receiving shades, repairs of security, water or light protection defects, repainting, shelving, etc… 2. Health Management Information System DISH activities focused on fostering a culture of information both at the district and the health sub-district levels, thus increasing the use of appropriate and timely information for planning, supervision and decision making. The Project directed special attention to the quality of data collection and analysis in order to provide accurate information for decision-making and for quarterly monitoring of MOH and Project indicators. This was achieved through periodic on-site support supervision, involving branch office staff members. The component also facilitated, in collaboration with the districts, data validation exercises, which addressed the issue of accuracy and quality in all facilities (i.e., beyond the DISH sentinel sites - see below). In order to promote the use of information for planning and decision making:
The ownership of information and information systems by district and health sub-district teams was thus a major objective of the work in this area, and was supported by the development of a more user-friendly computerised system at district level. The revised version of the HMIS software, including a standard reporting component and increased capacity for information analysis, was installed and put to work after district MIS staff had been updated in its application. The Ministry of Health is planning to install the system in all districts of Uganda. To view a demonstration of the HMIS please click here. For the purpose of Project monitoring, 80 facilities out of the twelve DISH-supported districts were selected into a Sentinel Site System; quarterly analysis of the information provided by the health unit monthly reports allowed district and Project managers to detect emerging trends and trigger additional investigations or strategic decisions. As an example, the following graph shows the declining trend of CYP coverage by method in 1999 and its recuperation in 2000 and 2001. The initial declining trend prompted an investigation of a possible shift of family planning clients towards the private sector.
The component also participated in the analysis of the information obtained through the Monitoring Surveys conducted during distributions of IEC materials and restocking of facilities with contraceptive supplies. 3. Supervision and Quality Assurance Initially, the component participated in the finalization of the National Supervision Guidelines led by the Quality Assurance Department of the Ministry of Health. It then supported the dissemination of these guidelines at district and sub-district level through provision of technical assistance and financial support for the dissemination workshops. Following the dissemination process, the emphasis was in supporting the actual implementation of the new supervision system. This was done mostly through the work of the Planning/Management Coordinators (and other branch office staff), who directly supported the planning and conduction of integrated or technical support supervision visits to health facilities. Funding for the supervision activities was shared between the project's grants and the districts' PHC funds. At the same time, the component, in close collaboration with the MOH and the other Project components, developed and implemented the quality improvement initiative called the Yellow Star Program. (For a detailed description of the Program, see: "Improving the Quality of Health Care Services Through Monitoring of Standards, Recognition of Performance: The Yellow Star Program" Best Practice) Within this area, following the definition and validation of the 35 Basic Standards for Quality of Health Services, the main activities of the component included:
By the end of the Project, the Ministry of Health had adopted the Yellow Star Program as a national strategy for quality improvement, to be rolled out in all districts by the end of 2004 and USAID had pledged its continuing support to the strategy through its follow-up projects. 4. Health Planning and Management/Health Care Financing A recent feature of the health services organisation in Uganda is the development of the health sub-district (HSD) as the operational unit for the planning, delivery and supervision of health services.
The Project thus supported the training of selected HSD staff in planning methodology and management, organised by the Health Planning Department/MOH and WHO. Meanwhile it provided technical support to the planning cycle/process at HSD level through the presence of branch office staff. Districts were also encouraged to use a portion of the district grant funds to support local planning (LC III level), in coordination with other resources available to them. The component had initially organised for the Health Planning Department a strategic planning workshop that informed the design of the decentralised district-level planning guidelines. In the area of health care financing, the abolition of user fees in public health facilities, effective March 1st, 2001, changed the whole country perspective and generated numerous discussions, studies and opinions. While DISH I had supported more effective collection of user fees in selected facilities, the component redirected its activities towards other areas of health financing:
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