MPIGI DISTRICT

HEALTH CARE SERVICE STATUS REPORT

August 2016

i

TABLE OF CONTENTS

LIST OF ACRONYMS ................................................................................................................................................. ii

Chapter One: BACKGROUND .................................................................................................................................. 1

1.1 About Us........................................................................................................................................................ 1

1.2 Background ................................................................................................................................................... 1

1.3 Specific Objectives of the Monitoring Exercise ............................................................................................. 3

1.2 Methodology ................................................................................................................................................. 3

Chapter Two: FINDINGS .......................................................................................................................................... 4

2.1 Human Resources for Health ........................................................................................................................ 4

2.2 Leadership and Governance ......................................................................................................................... 5

2.3 Medical Services............................................................................................................................................ 6

2.4 Medical Supplies ........................................................................................................................................... 9

2.5 Infrastructure and Equipment Management .............................................................................................. 12

2.6 Vermin Control ............................................................................................................................................ 16

2.7 Finances and Administration ...................................................................................................................... 16

Chapter Three: RECOMMENDATIONS .................................................................................................................. 20

ii

LIST OF ACRONYMS ANC – Antenatal Care

CAO – Chief Administrative Officer

DHO – District Health Officer

FY – Fiscal Year

GAVI – Global Alliance for Vaccines Initiative

HC – Health Centre

HMU – Health Monitoring Unit

HSD – Health Sub District

HUMC – Health Unit Management Committee

MRDT – Malaria Rapid Diagnostic Test

mTrac – Mobile Tracking

NMS – National Medical Stores

OPD – Outpatients Department

PHC – Primary Health Care

PNFP – Private Not For Profit

SMS – Short Messaging Service

UNICEF – United Nations Children’s Fund

VHT – Village Health Team

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Chapter One: BACKGROUND

1.1 About Us

The Health Monitoring Unit (HMU) was established seven years ago with a mandate to monitor health

services in the country.

HMU’s goal is to monitor the efficiency and accountability of Uganda’s healthcare system so as to raise

the bar in healthcare.

Our vision is to see a healthy Ugandan population supported by an effective and responsive healthcare

system. In order to achieve this, we continue to focus on striving for better health, better systems, and

better value for money.

Our core values are Quality, Undaunted, Integrity, Excellence and Teamwork.

1.2 Background

Mpigi district is a peri-urban district, with a population of 251,512 as of the 2014 population census. The

district is divided into two health sub districts (HSDs), namely: Mawokota North and Mawokota South. It

has only one hospital (Nkozi General Hospital – Mawokota South HSD headquarters) which is a Private

Not For Profit (PNFP) facility and one government HC IV (Mpigi HC IV – Mawokota North HSD

headquarters), which ought to be upgraded to a general hospital status.

HMU over time received numerous complaints about the status of health care service delivery through

various platforms including the mTrac dashboard as shown in table 1 below.

Table 1: Some of the complaints / reports received on the anonymous mTrac dashboard

Facility Date Reports Comments

Butoolo HC III

13/09/2016

We don't get medicine at butoro health center kammengo mpigi the situation is alarming please help DHT, for your attention

Butoolo HC III

17/07/2015

Musawo sekiipi Ku dwaliro a butoolo atujako Sente fe abalwadde ba pulesa ate tetulina sente

Buwama HC III

01/10/2016

Aba VHT EBUWAMA sub County twagema abaana polio nqa 1 ne 2 Dec.216 temwatuwa kantu konna yadde entambula lwaki kiri bwekityo

"We VHTs were given any facilitation when we immunized for polio 1 and 2"

Buwama HC III

23/04/2016

Ssebo abebuwama mutuwa eddagala tonno mutuyambe.

the drugs supplied to the health center are not enough

Kibumbiro HC II

23/05/2015

BANANGE TUKUBA OMULANGA KUDWALILO LYEKIBUMBILO TEMULIMUUDAGALA ELYAFFE ABALWADDE.

Please come to our rescue as we lack drugs at Kibumbiro Hc. DHT, for your immediate action and follow up

Kiringente Epi Centre HC II

14/08/2016

ENO EMPIGI KIRINGENTE,EKAGEZI,TUBEBAZZA OKUWA OMUSAWO AYITIBWA.MUSAWO SSEBATA.PETER, KUDWALILO KAGEZI EPICENTER. AKOLA.NE KU.WEEKEND, EKITALIWWO. Good Service Report

Kituntu HC III

03/09/2015

POOR SERVICE KITUNTU HEALTH CNTRE !!! MPIGI

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Facility Date Reports Comments

Mpigi HC IV

22/05/2015 No Drugs From Mpigi Health Centre

DHT, for your immediate action and follow up

Muduuma HC III

10/08/2016

Nze nemulugunya kuba sawo Muduuma heath center lll Mpigi District. Batandika okuttuka kuddelwaliro sawa (5) ate muddwaliro temuli dagala

Muduuma HC III

11/02/2016

Muddwaliro Emudduma - Mpigi, Abasawo Batusaba Sente Okutukebeera Omusayi, N'okutukula Amanyo Mutuyambe Tufaa, Bwoba Tolina Sente Tofuuna Bujjanjabi.

In Muduma HC III we are charged for blood tests and dental services. please help us, if you dont have money you dont get services

Muduuma HC III

18/12/2015

edwalilolyemuduumalyaganvumentnayebatusenteantenyinjibatandikirakumitwaloentanomubagambeko.

Muduuma HC III

13/08/2015

no drugs in muduuma health centre 3,mpigi district. why?

DHT, for your immediate action and follow up

Muduuma HC III

19/05/2015

HEALTH WORKERS AT MUDUUMA HEALTH CENTER ARE SO CARING THANK YOU BUT THEY COME LATE

Nabyewanga HC II

30/01/2016 Edwalilolyenabyewangatemulimubazalisa

"There are no midwives in Nabyewanga health centre"

Nabyewanga HC II

08/09/2015

NABYEWANGA HEALTH CENTRE II MUMPIGI TEMUBEERA DDAGALA KATI NAKU 3O. ABASAWO BTUUKA SAAWA TAANO KU DDWALIRO MUTUYAMBE TULIBUBI NNYO.

There are no drugs in Nabyewanga Hc II in Mpigi district for 30 days now. Health workers reach the facility at 11: am. please help us.

Nabyewanga HC II

25/06/2015

banange tusaba mutuyambe bekiikwatako empiji mukore orukiiko nga rugata abalwadde nabasowo muwuriire obuziibu byeturina kubanga tuffa.omwavu talwarenga?

Nabyewanga HC II

11/05/2015

akora mumateneti nansaba sente nemwegayirira anyambe nagana nambuza nt'omwavu azara?tubegayiride mutukyusizemu on'mukyara ye ayagara sente atuyisa bubi.

I was at nabyewanga the other day requesting for health worker to come to my rescue and she told me poor people donot deliver children or go into labor. She refused to help me unless I paid her money.

Nindye HC II

16/08/2015 NNINDYE H/C III temuli ddagala okumala sabiiti 2.

There are no drugs at nindye hc3. DHT, for your immediate action and follow up

Nkozi HOSPITAL

28/04/2016

MUTUYAAMBE KO ENKOZI TULINA ABASAWO BATONO.

"Please help us. We have very few health workers in Nkozi" DHT, for your attention.

Nkozi HOSPITAL

18/12/2015 Nkozi Hospital lacks opticians

Nkozi HOSPITAL

23/04/2015 Nkozi teli basauo kuba feabaluo tuo koye otuola

There are no health workers on duty at Nkozi Hospital. DHT, for your immediate action and follow up

Nsamu/Kyali HC III

28/06/2016

Edwaliro lye mu kwaba mpigi district kyali batunda edagala lya goverment

Sekiwunga HC II

28/06/2016

There is no services here at ssekiwunga health center 3, in mpigi district, please help us in those warkers thanks DHT, for your attention.

Sekiwunga HC III

06/10/2016

MORE PATIENTS NO NURSES IN SEKIWUNGA H/C (111), MPIGI DISTRICT,

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Facility Date Reports Comments

Ssekiwunga HC III

28/07/2015

SEKIWUNGA HEALTH CENTRE 3 MPIGI THEY DO HAVE ANY MEDICENI EVEN PANADOL OR ASPRIN

Ssekiwunga HC III

27/07/2015

i-)SEKIWUNGA TEBALINA DAGALA WANDE NE KAPANADO NEKA ASPRIN There are no drugs not even Panadol.

1.3 Specific Objectives of the Monitoring Exercise

To assess the level of effectiveness within the health service delivery systems of the district

through direct monitoring of health facilities.

To identify and rectify any forms of healthcare malpractice, poor administration and

mismanagement of healthcare resources.

To provide feedback to all stake holders involved in health service delivery as well as the public,

so as to jointly work-out practical solutions.

1.2 Methodology

The HMU team conducted site visits of Public and PNFP health facilities in the district. The evaluation

exercise took on the form of on-spot un-announced visits to selected health facilities, where monitoring

was conducted with the guidance of an approved data collection tool and observation checklists. Areas

of interest were: infrastructure and equipment inventory, medicines management and audit, financial

expenditure audit, staffing, administration and effectiveness of health services delivered at the visited

facilities.

At every health facility visited, on spot training of health workers was done in case of identified gaps

mainly in the areas of drug and records management, sterilization, accountability and mTrac.

Seventeen health centres were visited for assessment of health care service delivery as shown in table

two below.

Table 2: Health facilities visited

No. Facility Name Level No. Facility Name Level

1. Nkozi (PNFP) Hospital 10. Kampiringisa HC III

2. Mpigi HC IV 11. Ssekiwunga HC III

3. Bunjako HC III 12. Kyaali HC III

4. Buwama HC III 13. Nabyewanga HC II

5. Kituntu HC III 14. Bumoozi HC II

6. Ggolo HC III 15. Bukasa HC II

7. Butoolo HC III 16. DHO’s Clinic HC II

8. Muduuma HC III 17. Kibanda HC II

9. Nindye HC III

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Chapter Two: FINDINGS The findings of the monitoring visit are presented below in seven sub-sections, which are: (i) Human

Resources for Health; (ii) Leadership and Governance; (iii) Finances and Administration; (iv) Medical

Services; (v) Medical Supplies; (vi) Infrastructure and Equipment Management; and (vii) Vermin Control.

2.1 Human Resources for Health

Staffing Levels: The approved staffing norms are 48 staff at HC IV and 19 at HC III. Fig. 1 below shows the

staffing levels at the visited facilities as a percentage of the approved norm.

Generally, the facilities were adequately staffed; Mpigi HC IV the highest level public facility was well

staffed with 98% of the approved norm; while Buwama HC III with 116% had the highest staffing levels

owing to the high population served by the facility, Muduuma HC III was the third with 95% staffing

levels.

Unfortunately, with the exception of Muduuma HC III the good staffing levels were not matched with

good service delivery standards as it was curtailed by poor staff attitude and rampant absenteeism as

indicated below. It is not clear why Bunjako HC III had an outstandingly low staffing level.

Absenteeism: Despite the adequate staffing levels at the health centres, gross absenteeism was noted at

most facilities, which resulted in long patients’ queues and long waiting time. Most health centre in-

charges were not found on duty during the monitoring exercise citing that they were attending

workshops and carrying out quality improvement in the lower facilities.

Fig. 2 above shows the number of days facility in-charges had attended in the past two months as

obtained from staff attendance book (Arrival book). It is evident that only two (Mpigi HC IV and Buwama

HC III) had attended at least 30 days in two months, implying that the other seven did not deserve a

salary in those two months as they had not worked the minimum of 15 days a month. However, even

those with relatively high attendance there were glaring indications of forgery of attendance records as

staff could record for their colleaugues. This practice was most evident at Buwama HC III where it was

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clear that the in charge was never at the facility. It was found that the Askari and cleaner were managing

the OPD including updading the dispensing logs.

At Bukasa HC II on the day of the monitoring visit no health worker was found on duty by 11:00AM, yet

the duty roster indicated the facility had a total of seven (7) staff. The only person at work was the

Health Information Assistant (HIA) who had been newly recruited (5month in service). He was found red-

handed clerking patients, carrying out blood tests, prescribing and dispensing drugs to patients.

Mothers and patients stranded at Kampiringisa HC

III without being attended to by 11:00am

Warning notice against absenteeism at Nindye HC III

Abandonment of duty: A number of staff had abandoned duty and remained on the payroll drawing

salaries without rendering any service hence causing financial loss to government. An enrolled nurse at

Ggolo HC III had gone on annual leave in April 2016 and not returned for four months by the time of the

visit, yet the in-charge had not reported the matter to the DHO’s office.

Staff houses: Most health facilities except Muduuma HC III reported lack of adequate staff

accommodation as a reason for late reporting and early departures from duty. Mpigi HC IV with 47 staff

had only 16 housing units. Nonetheless the available staff houses however few, should be occupied by

the critical clinical staff and commuting to the place of work should never be accepted as reason for late

reporting.

At Butoolo HC III, a maternity ward had been turned into staff house.

2.2 Leadership and Governance

There was lack of quality supervision from the expected supervisory heads right from the district, to

health sub districts and to facility levels. The DHO and the entire DHT last visited Kituntu HC III over three

years (on 12th March 2013). Butoolo HC III and Kampiringisa HCIII had been supervised only once in the

last five years.

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Internal audit function does not examine, review and provide feedback to the lower facilities when they

submit accountability files, they are instead kept at the DHO’s office. For the last three years facilities

had not received feedback in regard to bookkeeping.

Most staff at the various facilities had not been oriented by their supervisors on how to perform their

duties for example most nurses that doubled as store keepers are not taught how to fill and update stock

cards with their requisition books.

2.3 Medical Services

Muduuma HC III was found to be a centre of excellence in the whole district in terms of service delivery

and stewardship. The OPD structure was neat one examination room, injection room, laboratories, and

mini-store. Staff quarters were very clean and staff were found on duty at the time of our visit. The

compound, maternity ward, toilets were all clean. The drug accountability was perfect using issue and

requisition books. The maternity ward was well managed with all records available.

On the other hand Kampiringisa HC III was rated the worst facility in terms of service delivery in the

whole district. A rift had emerged between the facility in-charge and the Kampiringisa remand home,

thus hindering the juveniles from accessing the health care services from the facility. The staff and In-

charge were constantly away from the facility and patients often had to wait for long hours to see health

workers.

The figures below show the number of OPD attendances and inpatient admissions in one month at the

visited facilities.

OPD Functionality: Generally, all health facilities were found running quite busy OPDs as shown in fig. 3

above. This implies a high disease burden in the district. Mpigi HC IV had the highest number of OPD

attendances closely followed by Buwama HC III.

General Admission facilities: Figure 4 above clearly depicts that Buwama HC III had the busiest inpatient

department even surpassing Mpigi HC IV which is at a higher level. Muduuma HC III inpatient

department was also well functional.

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It can be seen that the inpatient departments at Kampiringisa, Kituntu, Butoolo and Bunjako HC IIIs were

non-functional. This is despite the availability of admission facilities i.e. general ward and beds at all

these facilities.

Bales of mosquito nets were found heaped at facilities without being issued out and not used by the

patients on the wards, hence exposing patients and caretakers to new malaria infections from the health

centres.

Filthy admission mattress at Bunjako HC III Torn examination couch – Bunjako HC III

Functionality of Maternity and ANC Services: Figure 5 below clearly depicts a very low proportion of

deliveries conducted to total ANC attendances in all visited facilities (less than 30%).

Muduuma HC III had the highest proportion of Deliveries to Total ANC attendances i.e. 227 : 845 (27%)

followed by Mpigi HC IV and Ggolo HCIII both with 25%. The worst was Kituntu HC III where only 5% of

ANC attendances were delivered at the facility.

This can be attributed to the gross levels of absenteeism and poor attitude of health workers

characterised by use of rude language to pregnant mothers. This is worsened by extortion especially at

Mpigi HC IV where mothers had to buy a Mama kit at UGX 38,000/=, JIK and detergent. This illegality was

approved by the DHO and in-charge of Mpigi HC IV.

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Mpigi HC IV had 12 midwives and still complained of being understaffed but comparing with the ratio of

midwives to deliveries at the lower facilities e.g. Muduuma and Buwama, the complaint ceases to be

valid. This implies that there is pseudo-understaffing caused by absenteeism, poor duty roster planning

and abandonment of duty by some health workers.

An exceptionally performing

Midwife despite the chaos at

Ggolo HC III

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At Ggolo HC III maternity beds in good working condition had been turned into shelter for chicken as

shown in the picture below.

Ggolo HC III:

Admission beds in good working

condition turned into a chicken house

2.4 Medical Supplies

All health centres visited had drug stores and acknowledged regular delivery of essential medicines and

other supplies from National Medical Stores (NMS) every two months.

There was general mismanagement of the stores in almost all facilities, which had caused a financial loss

in terms of drugs pilferage. This was exacerbated by unauthorised inter-facility transfers of medicines

and other medical supplies. The worst case scenarios were at:

Ggolo HC III: Lacked consistent use of stock cards and issue and requisition vouchers at the

facility as there was free entry and exit to the medicine stores;

Kampiringisa HC III: There was gross mismanagement of the stores. Medicines were oftentimes

transferred to the district stores for redistribution yet resident patients were not given priority.

Moreover, the redistributions were without proper documentation and authorisation. Some

members of the DHT were reportedly involved in directly picking medical supplies from the

facility without the required authorisation;

Kituntu HC III: Lacked accountability for both PHC funds and medical supplies;

Butoolo HC III: The in-charge and stores in-charge failed to account for medical supplies;

Bunjako HC III: The medicine store was being managed by VHTs.

Ssekiwunga HC III: There was total mismanagement of mama kits and general poor

accountability of medicines.

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Mpigi HC IV: The medicines management focal person collects medicines from lower facilities but

they are not received into the HC IV stores records hence could not be traced.

Alterations were noted on stock cards as the quantity in and out and balance on hand figures would not

add up.

The following anomalies were common in most of the facilities;

DHO picking drugs from facilities with no written record for proper tracking of drugs to and

from her store at the district.

One requisition book is used in the entire facility for all departments like OPD, Maternity and

admission wards.

All laboratories manage their own determine kits.

Authorization control is jeopardized as issues out of the store are not approved by the head in

charge of the facility, the issuer and receiver never sign for what is taken and received which

makes tracking of drugs out of the store very difficult.

Missing entries in the requisition books and stock cards which made reconciling the two very

difficult.

Requisition and issue vouchers were not closed after issuing out items from the store.

Kampiringisa HC III: Unduly signed

requisition and issue voucher

Butoolo HC III: Medicines transferred to Mpigi HC IV without DHO’s

approval (Middle). Unduly signed requisition & Issue voucher (R)

An audit of the district medical stores revealed that essential medicines and other health supplies worth

UGX 38,743,175/= could not be accounted for. Worse still, losses through inter-facility transfers that

could not be accounted for, amounted to UGX 156,319,397. The total loss is over 195million shillings as

shown in the table below.

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Table 4: Unaccounted for medicines by the district medical stores

Item Total un accounted for

Pack size Unit Value Monetary value

Caps Amoxycillin (Tins) 139 1000 43,200 6,004,800

Tabs Paracetamol (Tins) 75 1000 12,420 931,500

Tabs Coartem (1*30*24) 80 30 191,311 15,304,880

Determine Test Kits (1*100) 14 100 293,760 4,112,640

MRDT (1*25) 212 25 40,500 8,586,000

Inj Quinine (Vial) 540 100 61,322 331,139

Inj Oxytocin (Vials) 500 100 20,196 100,980

Surgical gloves (Pairs) 100 50 47,222 94,444

Tabs Cotrimaxazole (Tins) 66 1000 33,232 2,193,312

Tabs Chlopromazol (Tins) 5

Tabs Fansidar (Tins) 5 1000 91,800 459000

Normal Salaine(Botles) 15 24 28,512 17,820

Tabs Metronidazole (Tins) 4 1000 11,971 47,884

Ampicilline (Vials) 150 100 38,336 57,504

Choramphenicol (Botles) 140 1 432 60480

Diazepam (Amps) 240

Diazepam (Tins) 9 1000 12,558 113022

Promethazine (Tins) 1 1000 8,923 8,923

Mebendazole (Tins) 5 1000 27,283 136,415

Maama Kits 3pc 1 21,060 63,180

Syringes (5ml) 300 100 18,507 55,521

Tabs Magnesum (Tins) 2 1000 10,789 21578

Tabs Amitripytillin (Tins) 3 1000 9731 29,193

CAF Eye (Bottles) 20 1 648 12,960

38,743,175

Other inter- facility losses

Caps Amoxycillin 56 1000 43200 2,419,200

Tabs Lumartem 477 30 191311 91,255,347

Inj Quinine 140 100 61322 85850

Tabs Paracetamol (Tins) 168 1000 12420 2086560

AZT/3TC 449 60

Determine Test Kits (1*100) 194 100 293760 56989440

MRDT (1*25) 86 25 40500 3,483,000

156,319,397

Expiries: Expired Medicines that had not been collected over a long period were few in most facilities

except Nindye HC III.

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Expired drugs at Nindye HC III

Newly constructed lab at Mpigi HC IV

2.5 Infrastructure and Equipment Management Tidiness of health facilities: Most facilities with the exception of Muduuma HC III, Nindye HCIII and Kituntu HCIII

were found unkempt.

Muduuma HC III: Well kempt and staff in uniform

Ceiling of Ggolo HC III infested with bats

Ggolo HC III: Dirty OPD patients’ waiting area

Old and dilapidated ceiling of Kituntu HC III

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Buwama HC III: New latrines constructed 1 year ago not in use (L); Old latrines still in use (R)

Fencing, Land Titles and Encroachment: Most of the visited facilities were not fenced; thus

compromising the security of persons and property of the facilities. Fencing also acts as a deterrent to

land encroachment. Land encroachment was reported at Butoolo HC III and Mpigi HC IV.

Ongoing constructions: On-going construction was observed at Nindye HC III where a maternity block

was being constructed.

Nindye HC III: Maternity ward under construction Poor medicine accountability at Butooro HC III

Stalled constructions: This was noted in Kampiringisa HC III, where the maternity ward structure had

stalled for over four years (since 2012), however, it was being used in spite of lacking any water supply

and as a result it was very filthy.

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Inventory and Equipment engraving: There was total lack of inventory management. Most equipment

could not be traced even when the record showed otherwise. Most government equipment in the

facilities were not engraved, which predisposes them to theft. The table below shows the status of

equipment inventory versus the physical count at the visited facilities.

Staff houses of Muduuma HC III Walkways of Mpigi HC IV

Table 4: Inventory status in health facilities

Facility Number PRINTER Maternity

beds

General

ward

beds

Computers Moto

cycle

Ambulance Fridges

Kit

un

tu H

C II

I

Stated in

book

- 5 9 1 1 - 1

Physical

count

- 4 9 1 1 - 1

Variance - 1 - - - - -

Ggo

lo H

C II

I

Stated in

book

- - - - - - -

Physical

count

- - 2 2 1 - 1

Variance - - - - - - -

Bu

too

lo H

CII

I Stated in

book

- 5 15 1 1 - -

Physical

count

- 5 13 1 1 - -

15

Facility Number PRINTER Maternity

beds

General

ward

beds

Computers Moto

cycle

Ambulance Fridges

Variance - - 2 - - - -

Ssek

iwu

nga

HC

III Stated in

book

- 8 7 1 - - 1

Physical

count

- 7 4 1 - - 1

Variance - 1 3 - - - -

Kam

pir

ingi

sa H

C II

I Stated in

book

- 10 14 1 - - 1

Physical

count

- 10 14 1 - - 1

Variance - - - - - - -

Bu

wam

a H

C II

I

Stated in

book

- - - - - - -

Physical

count

1 10 - 3 - - 1

Variance

Mp

igi H

C IV

Stated in

book

2 31 36 3 3 2 7

Physical

count

2 21 30 3 3 2 7

Variance - 10 6 - - - -

Presence and Functionality of Ambulance: At the time of our visit the district had two functional

ambulances.

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Utilities: At Kampiringisa HC III, the in-charge had not taken trouble to ensure that the newly constructed

maternity building is connected to water supply. Other facilities that lacked water supply were: Bunjako,

Butoolo and Buwama HC IIIs.

2.6 Vermin Control

All health facilities except Muduuma HC III were found heavily infested with bats, which make the

facilities filthy and emit a foul smell. The most affected facilities were Bunjako HC III, Ggolo HC III and

Kampiringisa HC III. All this is in spite of the fact that, the district an entomology office (vector control).

Ggolo HCIII:

Medicines store taken over by bats

2.7 Finances and Administration

An audit covering three financial years namely: FY2013/14, FY2014/15 and FY2015/16 was conducted.

The district health sector had received PHC funds both for recurrent expenditure (non-wage) and capital

development grants. It was also funded by partners like UNICEF, GAVI and Mildmay.

In FY2015/2016 PHC non-wage grant direct transfers to lower facilities was UGX 396,109,083/=; while

district health office PHC non-wage grant was UGX 52,553,803/= and PHC for capital development was

UGX 35,548,913/=.

In FY2014/2015 PHC capital development release was UGX 169,920,770/=; while in FY2013/2014 PHC

capital development release was worth UGX 189,939,169/=.

The table below shows a summary of queried funds, while a detailed report awaits responses from the

responsible officers.

Table 5: Summary of queried funds FY PHC Non-Wage &

Capital Development Unexplained Retention Fees

GAVI Funds UNICEF Funds Mild May Funds

FY2015/16 15,969,000 18,717,034 164,385,642 20,515,908 29,947,928

FY2014/15 14,220,000

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FY2013/14 230,020,040

TOTAL 260,209,040 18,717,034 164,385,642 20,515,908 29,947,928

In addition the following anomalies were revealed:

Norrkoping (U) Limited received a payment worth 101,286,432/= yet is NOT a prequalified

supplier as per the list obtained from procurement.

Retention fees for construction of maternity ward at Nindye HC III had been paid to the

contractor (WAMCO), although the building is not complete.

Lack of internal controls: Almost all lower health facilities visited, lacked controls to safeguard the

facilities’ assets that is cash and medical supplies. For instance none of the following controls were in

place:

Authorization of documents like requisitions and payment vouchers; money is paid out WITHOUT

formal approval from the heads of departments. The in-charge is the principal signatory to the

account and he/she can: make requisitions, withdraw money and then pay out.

There is NO segregation of powers, the in charge is the Accountant at the same time the head of

department to approve and make payments. Which raises a query as the in-charge solely controls

the cycle.

There was lack of transparency in the utilisation of PHC funds at the lower units as none of the facilities

was found displaying PHC releases and accountability for public viewing. It was also noted that

management of PHC was the preserve of the in-charge and a top secret.

Undeclared funds: On the 17/11/2015, a total of UGX 24,759,800/= was deposited on the Mpigi HC IV

account by UNRA as compensation for the facility’s portion of land encroached upon during the

upgrading of Mpigi–Maddu–Ssembabule Road. The health centre uses the same account for PHC funds

and other funds. The health centre failed to follow PHC guidelines which require a separate account for

PHC funds. By the time of the Audit, funds had already been spent without an approved budget and

work plan from CAO.

Variations in PHC releases to HSDs: Out of the DHO PHC non-wage recurrent grant a certain percentage

is to be paid to the health sub districts which are: Mawokota North (Mpigi HC IV) and Mawokota South

(Nkozi hospital) for monitoring and supervision of the lower Units as per the PHC guidelines section 5.0.

In FY 2015/16 the DHO’s office received UGX 52,523,803 and sent UGX 11,842,712 (23%) to Mawokota

South HSD (Nkozi hospital), however, in FY 2015/16 and 2013/2014, Mawokota North HSD (Mpigi HC IV)

did not receive any funds. And it was noted that most HSD funds received especially for Mpigi HC IV has

been spent on other activities rather than those stated in the PHC guidelines section 5.0.

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Extraction of funds as contribution to the health assistants: Lower health units were found to be

contributing funds to health inspectors and their Assistants as their inspection fee to facilitate their

transport. This resolution was passed by the district health team at the district meeting with the in-

charges in 2013/14 unfortunately there was no trace of the minutes from the DHO’s office.

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Table 6: Mawokota South HSD contributions for inspection from October 2014 – June 2015

FACILITY AMOUNT EXPECTED AMOUNT PAID BALANCE

Bukasa HC II 120,000/= 80,000/= 40,000/=

Buwama HC III 180,000/= 120,000/= 60,000/=

Bunjako HC III 180,000/= 120,000/= 60,000/=

Ggolo HC III 180,000/= 60,000/= 120,000/=

HSD referral unit 120,000/= 120,000/= 0

Kituntu HC III 180,000/= 120,000/= 60,000/=

Mitala Maria HC II 180,000/= 0 180,000/=

Nabyewanga HC II 120,000/= 80,000/= 40,000/=

Nindye HC III 180,000/= 120,000/= 60,000/=

TOTAL 1,440,000/= 820,000/= 620,000/=

Bunjako HC III contributed 50,000/= for April-June 2015/2016.

Mpigi HC IV’s contribution;

QTR AMOUNT

July-Sept15/16 420,000/=

Apr-Jun15/16 417,000/=

Jan-Mar 13/14 417,000/=

July-Sept13/14 417,000/=

TOTAL 1,671,000/=

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Chapter Three: RECOMMENDATIONS The team recommends that:

The CAO reprimands errant officers including DHO for Neglect of duty

The district constitutes a district health monitoring team and develops a comprehensive

supervision tool encompassing technical areas of healthcare service delivery and start conducting

comprehensive monitoring rather than sporadic monitoring of a few health centres.

All facility in charges should update and submit to CAO facility inventories of all infrastructure and

equipment at the facilities and immediately embark on engraving all equipment and furniture of

the facilities.

Health unit in-charges should be trained on financial management and accounting procedures.

All entities MUST display funds releases for public viewing.

Senior Assistant Secretaries (Sub County Chiefs) MUST carry out frequent on-spot checks at the

health facilities and regularly close the arrival registers by 9:00AM to deter late coming and

absenteeism.

Internal Auditors at the district should examine the PHC file accountabilities and give feedback to

the respective in charges through the management letter.

HUMCs should be oriented to understand their roles better.

The DHO’s office MUST coordinate all trainings and workshops because these leave health units

devoid critical staff and it has become a common excuse for absenteeism.

Health unit in-charges, caretakers of medicine stores and all health workers should be mentored

on proper medicines management procedures and put in place Standard Operating Procedures.