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WHERE IS THE MONEY FOR

FAMILY PLANNING SERVICES IN UGANDA?

FORUM FOR WOMEN IN DEMOCRACY (FOWODE)

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WHERE IS THE MONEY FOR FAMILY PLANNING SERVICES

IN UGANDA

is published by Forum for Women and Democracy (FOWODE) with support from the Results for Development (R4D)

© 2012

Forum for Women in Democracy (FOWODE)P.O. Box 7176, KampalaTel: +256-41-286063E-mail: fowode@fowode.orgWeb www.fowode.org

All rights reserved. No part of this publication may be reproduced, or reprinted in any form by any means without the prior permission of the copyright holder. Nevertheless, FOWODE and Results for Development (R4D) encourage its use and will be happy if excerpts are copied and used. When doing so, however please acknowledge FOWODE.

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WHERE IS THE MONEY FOR FAMILY PLANNING SERVICES IN UGANDA?

Forum for Women in Democracy (FOWODE) conducted a Public Expenditure Tracking Survey (PETS) of funds/materials allocated to Family Planning (FP) services right from the Ministry of Finance Planning and Economic Development (MFPED) through the Ministry of Health (MoH), National Medical Stores (NMS) and Health Centers (HCs) III and IV where family planning services are accessed by women at the grassroots communities in five districts of Uganda . The research sought to answer the following key questions:

1. What are the Family Planning services provided at the facility level?

2. How are funds/materials transferred from the central level to the health units

3. What is allocated in the budget for Family Planning services?

4. Do the money/materials reach the health unit? What guidelines/mechanisms are in place for

ensuring accountability of funds released for Family Planning services?

Key issues

• Only UGX 1,846,897,798 was allocated to Family Planning by the government of Uganda for the FY 2010/11

• Donors provided US $ 9,657,095, which is over 10 times Uganda government’s funding for Family Planning commodities.

• Government expenditure on Family Planning Commodities was on commodities that can only be used by women; implants, IUDs and Depo Provera

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• Overall, dispensing constituted only 40.0% of what was actually received by health units.

• 17 out of the 30 surveyed health units lacked separate cabins for storage of documents. There was an additional challenge of lack of qualified records assistants in half of the Health Centers surveyed.

Health Unit Management Committees (HUMCs) played no oversight roles in the management of Family Planning services including participating in accounting to the District Health Officers and communities.

Research Findings

1. Financing Family Planning: The study discovered that donors provided the bulk of funding for family planning in Uganda. In FY 2010/11 Only UG shs 1,846,897,798 (equivalent to USD 923,440) was allocated to Family Planning while donors notably UNFPA, USAID and DFID spent USD 9,657,095 on family planning during the same period.

Figure 1: Government Vs Donor funding towards Family Planning services

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Government’s per capita expenditure on family planning commodities for women of reproductive age was UG shs 223 of USD 0.09 while Donor’s per capita expenditure on family planning commodities for women and men of reproductive age amounts to USD. 0.56. If the demand for Family Planning commodities was to rise, US $ 7.4 is the recommended per capita expenditure.Government should substantially increase its allocations for family planning commodities to US $ 7.4 per capita.

Government expenditure on Family Planning was on commodities that can only be used by women; implants, IUDs and Depo Provera.

Figure 2: Government expenditure on Family Planning Commodities.

Government should also procure family planning commodities used by men, especially condoms.

2. Family Planning Services Offered at Health Units: Family planning services (commodities and requisite surgery where necessary) provided at health facility level differ by level of facility, personnel and equipment available

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at the facility. For example, IUDs and implants are not provided at Health Center IIIs Miriam disputes this. These services are provided at Health Center IVs which should ideally have a medical doctor and a theater. However, not all health centre IVs have medical doctors and/or theaters. Of the 10 surveyed Health Centre IVs, only 4 (Kakindo in Kibaale, Awach in Gulu, Nyimbwa and Luwero both in Luwero district) had doctors. Health Center IVs lacking doctors can therefore not provide services like IUDs and implants.

All Center IVs should have skilled medical

personnel and surgical equipments required for family planning services.

3. Tools for Delivery and Receipt of Family Planning Commodities. Whereas the NMS and health units utilize the tools for delivery and receipt of family planning

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commodities, respectively, there is still room for improvement. The survey revealed discrepancies in the records of supplies both at the National Medical Stores and several health units for most health centers. First, NMS delivery notes are written in Entebbe with details of dates, types and quantities of FP commodities to be delivered to each health unit. Ideally, health units ought to sign the delivery notes upon verifying the types and quantities actually delivered. But in several cases, the delivery forms are signed when the quantities indicated as delivered are less or more than what is written on the NMS delivery forms. In other words, in several cases, health units’ countersigning of delivery notes is perfunctory. See examples in the table below:

Period Distr ict National Medical Stores Delivery records

Health Center Received records

Muko Health Center IV, Kabale

Commodities worth US $ 2,677.6 were delivered

Commodities worth US $ 6,891.05 were received.

Kamukira Health Center IV, Kabale

Commodities worth US $ 5,800.805 were delivered

Commodities worth only US $ 1,545.355 were received

FY 2010/11

Nabuli Health Center III, Kibuku

Commodities worth US $ 745.5 were delivered to

Commodities worth only US $ 499 were received

 

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3.1 Lack of qualified Records Assistants:There was a general lack of qualified record assistants in over half of the health centers surveyed. Records were in some units made by midwives because family planning commodities were associated with maternal health, but some are overwhelmed with numbers of expectant mothers to attend to; hence no time to even record in-coming and dispensed commodities. In other cases, staff tasked with making entries into stock cards could not distinguish between different types of commodities. For example in Zirobwe Health Center III, it was observed that the stores and records assistant always failed to distinguish between Levonorogestrel 0.03mg 3 cycle commodities in the blue packets and other packed in red packets. Stock cards for the two commodities were not properly prepared and no meaningful information could be extracted from the stock cards during this survey.

Qualified records assistants should be recruited in Health Centers.

3.2 Data processing was also a problem in all health units due to break down of their computers which were not regularly serviced and/or sufficiently protected from viruses. In addition, costs of photocopying monthly report forms and stock cards were prohibitive to most health units which did not have electricity and had to travel miles to do so. Intermittent electricity supplies further increased costs of photocopying because the photocopying business entities had to

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rely on generators. Transport for delivering reports to the District Health Officers was also a problem since all health units lacked transport facilities. In the rural areas, Health Center staff had to hire bicycles out of the already meager non wage PHC grant. Since the transport line item was not catered for, this delayed delivering accountability reports to the District Health Officers.

Health Centers should also be equipped with functional data storage and processing equipment especially computers with adequate funding for servicing and virus protection.

3.3 Record Keeping Facilities: 17 out of the 30 surveyed health units had poor storage facilities for general medical drugs and Family Planning commodities. Storage space was small, lacked shelves and cupboards such that some commodities and drugs were kept on the floor, on top of each other and/or in boxes which according to the in-charges, made it difficult to retrieve the drugs/commodities. Nabuli Health Center III had only 2 delivery notes and all records were kept at the midwife’s home, hence very susceptible to loss.

Health Centers should be availed records keeping facilities notably filing cabinets.

4. Transfer of Funds/Materials From the Central Level to the Health Units: The survey revealed that the supply of Family Planning commodities to Health Centers by the National Medical Stores was not streamlined. There were cases of infrequent deliveries to health units that

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were not based on availability of surplus commodities from previous deliveries but on inaccessibility (hard to reach) of health units, misinformation about closure of some health units and misallocations by the National Medical Stores, whereby some health units received more than was recorded by the National Medical Stores while other units received less than was recorded by the National Medical Stores.

National Medical Stores should streamline the supply of Family Planning commodities to the Health Centers for proper records and accountability.

5. Dispensing of family planning commoditiesattheHealthCenters: Overall, dispensing constituted only 40.0% of what was actually received by health units. In some Health Centers for example Bulangila Health Center III, in Kibuku District, dispensing constituted only 11.3%. In Kamwezi Health Center IV in Kabale, District, it was 28.8%. Nonetheless, all was not grim since Bukinda Health Center III dispensed all the commodities it received, Kamukira Health Center IV also in Kabale District dispensed 83.8% and Kyanamira Health Center III also in Kabale District dispensed 76.4%.

Given the low dispensing levels of FP commodities, it is evident that the accountability to communities is not effective. Deliberate efforts should be made to intensify accountability to communities through sustained IEC campaigns. Targeting males is also recommended because most males do not visit health units and do not attend community health

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outreaches as much as women do. Hence, health unit/health outreach settings for dissemination of family planning IEC do exclude males.

Health Unit Management Committees.

All health units with the exception of Awach Health Center IV in Gulu district had Health Unit Management Committees. All Health Unit Management Committees were male dominated and instead of meeting quarterly, 3 had not met at all during FY 2010/2011, citing lack of funds while 19 met once or twice during the FY. In addition, none of the minutes of the meetings seen by the research team had ever had Family Planning on its agenda. Besides sometimes verifying the types

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and quantities of Family Planning commodities delivered, Health Unit Management Committees played no oversight roles in the management of Family Planning services including participating in accounting to the District Health Officers and communities.

The roles of Health Unit Management Committees in accounting to the District Health Officers and communities should be strengthened.

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Thefollowingrecommendationsaremade:

Government should substantially increase its allocations for family planning commodities to US $ 7.4 per capita.

Government should also procure family planning commodities used by men, especially condoms because implants, IUDs and Depo Provera that Government expenditure on family planning services procures are commodities that can only be used by women.

Donors should increase per capita spending on Family Planning commodities to US $ 7.4

Records of the National Medical Stores supplies of Family Planning commodities to Health centers need to be streamlined to minimize inconsistencies in both National Medical Stores and health center supplies and delivery records.

Demand for Family Planning commodities amongst communities should be enhanced through strategies that cover non health unit/health outreach settings such as community social and economic settings for example markets, agricultural advisory services’ meetings, community halls or even clubs and bars where males are more likely to be found.

Family planning IEC could also be packaged and delivered in

Financing Family Planning:

Supply of family planning commodities

Community awareness and utilization of family planning commodities

AREA ASSESSED

RECOMMENDATION

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Community awareness and utilization of family planning commodities

Record Keeping:

Management of family planning services:

AREA ASSESSED

RECOMMENDATION

economic and social terms such as linkages between family planning adoption and economic productivity, financial savings, a planned life and a more physically vibrant wife, children and family as a whole.

In the short run, some funds for procuring Family Planning commodities could be diverted from procuring the commodities to conducting IEC campaigns for Family Planning utilization within communities. Once demand increases, the funds could be re-channeled back to purchasing Family Planning commodities

Qualified records assistants should be recruited in health centers

Health centers should be availed with data storage and processing facilities especially computers with adequate funding for servicing and virus protection

Funding for stationery, photocopying and transport to District Health Offices should be availed to reduce delays in forwarding accountability reports

The roles of HUMCs in accounting to the District Health Officers and communities should be strengthened.

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Conclusion

One way of improving safe motherhood indicators in Uganda is ensuring that family planning services are accessible and utilised. Family planning is one of the key priority areas of funding for the Ministry of Health (MoH) under its Reproduction Health Division. We therefore call upon the Government of Uganda to increase funding towards family planning services.

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Forum for Women in Democracy (FOWODE)

P O BOX 7176, KampalaTel: + (256) 041 4 286063

Email: fowode@utlonline.co.ug Email: fowode@fowode.org

Web: www.fowode.org

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men equally participate in and benefit from decision making process

MISSION:Promoting gender equality in all areas of

decision making through advocacy, training, research and publications.