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Human Resource for Health (HRH) Database Linkage and Harmonisation in Uganda. Maniple EB , Biesma RG, Byrne E & Brugha R CHRAIC Programme Dep’t of Epidemiology & Public Health Medicine, Population Health Sciences Division, RCSI.

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Human resource for health hrh database linkage and harmonisation in uganda

Human Resource for Health (HRH) Database Linkage and Harmonisation in Uganda

Maniple EB, Biesma RG, Byrne E & Brugha R

CHRAIC Programme

Dep’t of Epidemiology & Public Health Medicine,

Population Health Sciences Division, RCSI

Acknowledgements: MOH Uganda, Uganda Faith-based Medical Bureaux, IntraHealth, IFGH, CHRAIC programme,


Uganda
Uganda Harmonisation in Uganda

  • East Africa

  • 34 million people

  • 82% in rural areas

  • GNI US $350 per capita p.a.

  • 0.08 doctors/1000 people

  • 4 medical schools, 27 Nurse Training Schools, 3 Clinical Officer schools

  • Health care: Gov’t, PNFP, PHP, TCM


Background
Background Harmonisation in Uganda

  • Human Resources for Health (HRH) crisis

    • global but developing countries worst affected

    • 46 of 57 countries below density of 2.5/1000 population were from Sub-Saharan Africa

    • Uganda had 0.08 doctors/1000 population

  • Poor Human Resources Management (HRM) is a key aspect of the HRH crisis

  • Lack of comprehensive and reliable data on HRH negatively affects planning, deployment, supervision and management of staff

  • Staff maldistribution exists between and within countries, with rural areas worst affected, but no analysis of rural-urban distribution


Background ii
Background (II) Harmonisation in Uganda

  • GHWA’s 2008 Kampala Declaration and Agenda for Global Action calls for establishment of workforce information systems

  • Uganda

    • set up a HR Information System (HRIS)

    • conducts periodic audit of health workers to ensure smooth management of the payroll and reduce on “ghost workers”


Problem statement justification
Problem Statement & Justification Harmonisation in Uganda

  • Inequitable distribution of health workers negatively affects right to equitable access to quality health care

  • Lack of comprehensive and accurate information on HRH limits ability to plan improvements in distribution and management of staff, wastes resources

  • Overworked staff are demotivated and dangerous, hence need to know under-staffed areas and skills

  • Fragmented information is a waste of resources, hence need to integrate HRH information from entire sector


Objectives
Objectives Harmonisation in Uganda

  • To determine the geographic and skill mix distribution of qualified health workers in Uganda

  • To identify the current efforts to improve the quality of available information on the distribution of health workers

  • To determine the level of integration of data on the distribution of health workers

  • To identify the successes and challenges of producing high quality information on the distribution of health workers


Methodology ii
Methodology (II) Harmonisation in Uganda

  • Review of

    • Documents:

      • HRH Audit Reports (2010, 2009)

      • Sector Performance Reports (2011, 2010, 2009)

      • Sector Plans: HSSIP, Health Policy

    • Existing HRH databases: MOH, UCMB, UPMB, UMMB

  • In-depth Interviews:

    • MOH (Personnel Department, Resource Centre)

    • 3 Faith-based medical bureaux

    • NGO (Capacity Project/IntraHealth)


Findings i geographical and skill mix distribution
Findings (I) - Geographical and Skill Mix Distribution Harmonisation in Uganda

  • Government:

    • 47,173 approved posts but only 56% (24,914) filled with qualified staff

    • Most of the remaining 44% are filled but with unqualified staff

    • Central region best and worst staffed (Range: 42% to 123%)

    • Worst staffed district in Northwest (19%)

  • Other subsystems:

    • Private practitioners: No centralised data

    • PNFP:

      • No comprehensive data on approved positions

      • Only 35% of staff are qualified

    • TCM: No data, no known qualification, no structure

  • Skill-mix distribution: Analysis on-going


Findings ii geographical and skill mix distribution
Findings (II) – Geographical and Skill Mix Distribution Harmonisation in Uganda

Source: MOH Uganda and IntraHealth, 2010: Human Resources for Health Audit Report 2010


Findings iii efforts to improve quality of information
Findings (III) – Efforts to Improve Quality of Information Harmonisation in Uganda

  • Establishment of positions of

    • Records Assistant at health facility level

    • Biostatistician at district level

  • Recruiting & training data managers

  • Decentralisation of HMIS stationery management

  • Supply of computers and internet connection

  • Web-enabled report forms (UPMB)

  • Regular feedback (UCMB)


Findings iv quality of information
Findings (IV) – Quality of Information Harmonisation in Uganda

  • Only MOH database attempts a geographical analysis

  • No database analyses health-worker skills


Findings v database linkage and integration

Government health facility Harmonisation in Uganda

District level

MOH HRIS

Catholic health facility

Diocese level

UCMB HRH Database

Protestant health facility

UPMB HRH Database

National HRH Database

Diocese level

Muslim health facility

District level

UMMB HRH Database

National Private Practitioners HRH Database

Private health facility

District level

Traditional Medicine practitioner

District level

National level Traditional Medicine HRH Database

Findings (V) – Database Linkage and Integration

Key

Red/dashed= lacking structure or link


Findings vi database linkage and integration
Findings (VI) – Database Linkage and Integration Harmonisation in Uganda

  • No comprehensive national database covering the entire health sector

  • Parallel databases operated by subsectors

  • No linkage of databases at any level

  • No common format, hence different levels of detail

  • No integration

  • Data only shared upon request

  • No joint meetings to discuss the issue


Findings vii successes opportunities
Findings (VII) – Successes & Opportunities Harmonisation in Uganda

  • All subsystems, except private practitioners and TCM practitioners, have HRH databases up to national level

  • Presence of web-enabled electronic databases

  • Internet access in most parts of the country


Findings vii challenges threats
Findings (VII) – Challenges & Threats Harmonisation in Uganda

  • Lack of a policy compelling all to report

  • Lack of communication and formal structures for communication between subsystems at different levels

  • Multiple formats and software

  • Inadequate funding, IT facilities and technical capacity especially at lower level facilities


Findings viii challenges threats
Findings (VIII) – Challenges & Threats Harmonisation in Uganda

  • High staff turnover especially in PNFP subsector

  • Low demand for HRH data (MOH asks only for clinical outputs)

  • Lack of a policy on data governance and security

  • Lack of unique staff identifier (no National ID)


Discussion
Discussion Harmonisation in Uganda

  • Regional and rural-urban imbalance in staff distribution exists in Uganda but is poorly documented

  • Lack of relevant supportive policies creates room for low investment in HRM systems and non-reporting

  • Presence of 4 national HRH databases is an opportunity to be exploited

  • Low demand for HRH data provides no incentive for investment in data linkage, analysis and utilisation


Recommendations
Recommendations Harmonisation in Uganda

  • To Ministries of Health and ICT to prepare a national policy on electronic databases

  • To MOH and faith-based Bureaux to harmonise the formats of minimum data collected on HRH

  • To MOH and faith-based Bureaux to analyse and share HRH data more regularly than is the case


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