PADER DISTRICT LOCAL

GOVERNMENT
HEALTH DEPARTMENT

A BUDGET FRAMEWORK PAPER CONCEPT FOR THE FINANCIAL YEAR

2011/12 PRESENTED AT THE BUDGET CONFERENCE HELD AT PADER
DISTRICT COUNCIL HALL ON THE 18TH JANUARY 2011
 JANUARY 2011

1.1 MISSION STATEMENT

“To provide quality, accessible, affordable and equitably distributed health

services, focusing on National and Local priorities, in order to improve the health
status of the people of Pader District”.

1.2 GOAL AND SPECIFIC OBJECTIVES

1.2.1 GOAL
The district health sector goal is the same as the National goal, which states that
we aim at :

“Reduced morbidity, mortality and disability from the major causes of ill-health
and premature death, and reduced disparities therein”.

1.2.2 SPECIFIC OBJECTIVES

1.1.2.2 To develop and strengthen the human resource pool for

the optimal provision of quality health services
1.1.2.3 To strengthen the integrated support systems at all levels
1.1.2.4 To provide the minimum health care package of services
to all the people of Pader District with adequately
planned for inputs.
1.1.2.5 To provide a network of functional, efficient and
sustainable health infrastructure for effective health care
 delivery closer to the people
1.1.2.6 To ensure effectiveness, efficiency and equity in the
allocation and utilization of resources and mobilizing
more resources with emphasis on transparency and
accountability
1.1.2.7 To ensure that communities are empowered to take
responsibility for their own health and well being, and to
participate actively in the management of their health
services
1.1.2.8 To promote a healthy partnership with private not for
profit sector so that they also contribute to uplifting of the
health status of the population
1.1.2.9 To promote research in health for development

1.3 The health delivery system

The district has a total of 27 health units. There is 1 hospital, 1 health Centre IV,
11 Health Centre IIIs and 14 Health Centre IIs. There is 1 health sub district
corresponding to the only parliamentary constituency in the district. The District
Health Office provides overall direction and oversees the health services in the
district. The Health Sub-District also assists in conducting closer support
supervision and implementation of the Minimum Health Care Package. The
implementation of health services is ensured through a network of health centers
III, II and Village Health Teams situated in the subcounties, Parishes and villages
respectively.

The table below gives details of the health units in the various subcounties, in
addition to the staffing levels in each unit.

Table 1 : Summary table detailing the health units,functionality and staffing levels
HSD S/counties Health units (Level & Staffing levels
ownership)
Recommend Actual Co
ed m
me
nts
1. Aruu Atanga Atanga HCIII-Govt. 19 12
Lawiye-adul HCII-Govt 9 0 NO
Angagura Angagura HC II-Govt 9 6
Aswa Ranch HCII-Govt 9 0 NO
 Laguti Laguti HC III-Govt. 19 9
Amilobo HC II-Govt. 9 5
Wipolo HC II-Govt. 9 1
Pakeyo HCII-Govt 9 0 NO
Paibwor HCII-Govt. 9 0 NO
Acholibur .Okinga HC II-Govt. 9 5
Latanya Acholibur HC III-Govt. 19 10
Latanya HC II-Govt. 9 5
Porogali HC II-Govt 9 5
Dure HC II-Govt. 9 4
Lapul Lapul HCIII-Govt 19 0 NO
Alim HC II-Govt. 9 10
Lawire HC II-Govt. 9 7
Mary Immaculate Hc II- 9 2
Govt.
Pajule Pajule HC IV-Govt. 48 29
Paiula HC II-Govt. 9 3
Oguta HC II-Govt. 9 5
Ogago HCII-Govt. 9 6
Oryang HCII-Govt 9 0 NO
Kilak Kilak-HC III-Govt. 19 7
5th Division Hospital - -
Ogom Ogom HC III 19 0 NO
Puranga Puranga HC III-Govt. 19 12
Ogonyo HC III-Govt. 19 7
All Saints HC II-NGO 9 4
Oret HCII-Govt 9 0 NO
Awere Awere HC III-Govt. 19 12
Rackoko HC III-NGO 19 23
Lagile HC II-Govt. 9 9
Bolo HC II-Govt. 9 1
Angole HCII-Govt. 9 0 NO
Pader TC Pader HC III-Govt. 19 24
Pader TC 5 2
DHO’s office 9 trained
3 support
staff
TOTAL 11Subcounti Govt units and 3 NGO 206-govt.
es units employees
1 Town 29-NGO
Council staff
NB: NO=Not operational
Source: Staff audit summary report

1.4 Other health service partners include

1. AVSI(International Volunteer’s Service Association):Supports Kalongo
Hospital by supporting qualified personnel and equipment. It currently is
supporting the PMTCT programme in Aruu HSD and VCT services in Aruu
HSD. It has constructed/rehabilitated a number of units and provided furniture
and esential drugs.
2. Gulu Catholic Diocese: Supports All Saints Dispensary and Mary
Immaculate HC IIs.
3. Uganda Australian Foundation: Offers a cocktail of services at Rackoko
Health Center-promotive, preventive and curative.
4. Malaria Consortium-is currently supporting Malaria control activities.
5. UNICEF supports a myriad of maternal and child health activities in the health
sector which include: Reproductive Health (Adult & Youth Friendly services),
HIV/AIDS/PMTCT, EPI, Home Based Care for childhood illnesses, Nutritional
Rehabilitation, Water and sanitation.
6. WHO-supports surveillance activities, strengthening support supervision,
promoting CB-DOTs, introducing the VHT concept, introducing community
Co-ARTEM distribution.
7. AMREF supports immunisation activities, Home Based Care and water and
sanitation interventions.
8. Christian Counselling Fellowship: This is a CBO established primarily to
assist the formerly abducted child mothers.
9. Medical Teams International – Integrated Health services.
10. PATHFINDER-supports safe motherhood interventions.
11. Marie Stopes Uganda-also supports safe motherhood interventions-
specifically Family Planning.
12. CONCERN-supports WATSAN activities.
13. UNFPA-supports Gender Based Violence and safe motherhood responses.
14. COOPI- supports Gender Based Violence activities.
15. WHO-supports Mental Health, Integrated Disease Surveillance.
16. TPO-supports Mental health activities.
17. NUMAT-supports Malaria, TB and HIV/AIDS activities.
18. Baylor Uganda-supports Paediatric HIV/AIDS programmes.

1.5 REVIEW OF PERFORMANCE

1.5.1 FINANCIAL RESOURCES

A 1: Planned Actual Comments
Financial
resource
s

A 1.1 Total public 1.296 1.154 INADEQUATE

(GoU ) allocation to
health per capita
A 1.2 PHC Wage 583.494.672 519.254.203 89%

A 1.3 PHC 143.223.300 135.045.548 94.3%

Recurrent Non
Wage (Total)
A 1.3.1. DHO 38.481.521 35.074.167 91.2%
A 1.3.2 HSDs 104.741.779 99.968.381 95.4%

A 1.3.3 PNFP 568.498.000 531.545.633 93.5%

units
A 1.4 PHC 2.492.581.689 2.314.500.000 92.9%
Development (Total)
A 1.5 Percentage of 100% 85% The balance was
disbursed PHC CG retention
funds expended fees/funds for
construction
 A 1.6 Proportion of - - NO LONGER
PHC funds used for SENT TO THE
drugs DISTRICT
A 1.7 Proportion of 100% 9.6%
the budgetary
District Local
Government
contribution
disbursed
A 1.9 Percentage of 100% 90%
disbursements from
development
partners

1.5.2 PROGRAMME INDICATORS

Indicator Planned Actual Comments

A 3:Information A 3.2 Proportion of health 100% 95%

management facilities submitting timely
HMIS reports
A 4.3 Proportion of health 100% 35% .there was an
units without stock outs of interrupted
any of the following; supply for over
chloroquine, SP, 6 months
cotrimoxazole, ORS,
measles vaccine & depo
provera
B1: B 1.1 Malaria Control Poor data
Communicable reporting by
Disease Control B 1.1.1 Proportion of <5s 50% 49% VHTs
receiving effective treatment
for malaria within 24 hours
of onset of symptoms
(HBMF) Data)

B 1.1.2 Proportion of <5s 100% 122% Results from

protected by ITNs IRS exercise
B 1.1.4 Proportion of 50% 56% Above target
pregnant mothers who
receive 2 doses of SP during
ANC visits
 B 1.2 Tuberculosis control Above target

B 1.2.1 TB case 70% 75%

notification rate
B 1.2.2 TB cure rate 85% 88% Above target

B 1.2.3 Community DOTS 100% 41% Low coverage

coverage (S/county as unit
of coverage)
B 1.3 HIV/AIDS Control From ANC data
B 1.3.1 Urban/rural HIV 11% 6.4%
seroprevalence
B 1.3.2 Total number of 22 24
VCT centers (include AIC)

B 1.3.3 Total client load for

all VCT centers
B 1.3.4 PMTCT
Number of mothers 18004 12231 68%
counselled
Number of mothers 18004 12231 100% of the
tested counselled
Number of mothers 156 117 75.1%
enrolled
B 1.3.5 Number of patients 4951
started on ARV therapy
(new clients)
B 1.3.6 Early Infant 5932 6901 116%
Diagnosis of HIV/AIDS

B 1.3.6 Number of people

treated under NTDs
1.IVM 357 750 248 491 69.5%
2. Albendazole 365 932 325 230 88.9%
3. Zithromax 365 932 317 753 86.8%
4. Praziquantel 357 750 138 912 38.8%
B 2: B 2.1 Percentage of health 40 29 73%-funds sent
IMCI(integrated workers trained in IMCI for one training
Management of
Childhood
llnesses)
B 3: Sexual and B 3.1 Proportion of new 22505 18004 80%
reproductive pregnant mothers attending
health ANC
 B 3.1 Proportion of pregnant 30% 52% Above target
mothers attending ANC at
least 4 times
B 3.2 Percentage of 50% 34% Below target
deliveries taking place in
GOU and PNFP facilities
B 3.4 Couple Years of 15000 13377 Below target
Protection (CYP)

B 4: B 4.1 DPT3/ HepB + Hib 80% 87% Above target

Immunisation coverage
B 4.2 TT 2 coverage- 55% 50% Below target
Pregnant
TT 2 coverage- Non- 50% 40%
pregnant
B 4.3 BCG coverage 90% 86% Below target
B 4.4 Measles coverage 90% 87% Below target
B 4.5 Polio third dose 90% 83% Below target
coverage
B 5: B 5.1 Pit Latrine coverage 40% 40% On target
Environmental
Health
B 5.2 Proportion of the 60% 47.2% Added efforts
population with access to by NGOs has
safe water led to a slight
increase
B 6.1 Proportion of VHTs 100% 100%
B 6: Health formed/established
education and
promotion

B 6.2 Proportion of VHTs 100% 100% Only 79%

trained currently active
B 7.2 Percentage of Primary 100% %
schools with adequate Pit
Latrine stances according to
the national standards (1:40)
B 7.3 percentage of Primary 50% %
schools with functional safe
water sources within ½ km
radius
B 8: Nutrition B 8.1 Vitamin A 95% 95% On target
Supplementation coverage

B 8.2 Proportion of 100% 100% All salt is

Households consuming iodised
Iodised salt (use samples
brought by school children)
B 9: IDSR B 9.1 Proportion of H/units 100% 100%
with at least one person
trained in IDSR
B 10: Mental B 10.1 Proportion of 2 2-
Health hospitals and HCIVs with KALONGO
health workers trained in Hospital &
mental health Pajule
HCIV
B 10.2 Number of mental NA 1953 Most are
health cases seen in OPD epilepsy cases
and outreaches
B 11: Clinical B 11.1 Infection Control
Care - Proportion of health 100% 100%
facilities with hand
washing and antisepsis
facilities

- Proportion of health
facilities with spills 100% 60.9%
management practices

- Proportion of health
facilities practicing the 100% 78.2%
recommended
mangement of health
care waste

B 11.2 Disability
Prevention/Rehabilitation 0 0 No funding
-Proportion of HSDs with
trained Focal Persons for
disability

-Proportion of health 100%

facilities with ramps for the
PWDs
0 0
-Number of assistive devices
procured
B 11.3 Oral/Dental Health

- Proportion of HC Ivs with 1 1 Only Kalongo

functional Dental health Hosp.
Units
C: Health Sector Support
Functions
C 2.2 Technical support 4 4
visits (DHT to HSDs)
 C 2.3 Technical support 24 4 Inadequate
visits (HSDs to LLUs) funding
C 2.5 Proportion of HC 3s 100% 62% Laguti, Kilak,
with functional laboratory Puranga HCIIIs
services lack labs

D: Quality of care
D1: Accessibility D 1.1 Percentage of the 50% 40%
to services population within 5 km of a
public or PNFP health facility
providing the MHCP
D2: Services D 2.1 Total government and 1.0 1.2 Above target
utilisation NGO OPD utilisation per
person per year
D3: Consumer D 3.1 Percentage of the NA NA The population
satisfaction population expressing ranked the
satisfaction with health health
services department as
the best in the
district over the
radio

1.6 Strategies of the health department to achieve its mission and ensure
health for all and overall socio-economic development

1.6.1 Intensifying health awareness and behaviour change

1.6.2 Strengthening community capacity for health promotion and improved
health service delivery
1.6.3 Strengthening interface between service providers and consumers
1.6.4 Formulation of appropriate by-laws, ordinances and regulations for
improved Environmental health
1.6.5 Provision of safe water for the communities and water quality surveillance
1.6.6 Strengthen disease surveillance, epidemic preparedness and
Response
1.6.7 Prompt and appropriate case management and referrals
1.6.8 1.6.9 Strengthen co-ordination efforts in health service delivery
1.6.10 Operationalise emergency obstetrical care services
1.6.11 Scale up Goal oriented Ante Natal care and post natal care
1.6.12 Scale up Prevention of Mother to Child transmission of HIV/AIDS
1.6.13 Implement Integrated Management of Childhood Illnesses and Integrated
Commnity Case Management of childhood illnesses
1.6.14 Strengthen community integrated management of Acute malnuteition.
1.6.15 Strengthen Expanded Programme on Immunisation
1.6.16 Strengthen control of communicable and non-communicable diseases.
1.6.17 Scale up of HIV/AIDS prevention, care, treatment and support services
1.6.18 Recruitment of staff
1.6.19 Strengthening support supervision of health workers and providing
feedback
1.6.20 Developing and circulating a league table rating performance of the health
facilities and funds disbursed and utilized per quarter
1.6.21 Promoting male involvement in health
1.6.22 Develop and tracking performance indicators and targets for all health
cadres for Results Oriented Management
1.6.23 Consolidate the functionality of existing health centers.

1.7 SWOT ANALYSIS

STRENGTHS

1. Healthy inter-sectoral collaboration

2. Available resources (staff, transport, office equipment, logistics)
3. Political will
4. Improved communication network

WEAKNESSES

1. Inadequate number of trained health staff

2. Inadequate space and infrastructure for health service delivery
3. Ill-equipped units
4. Fairly difficult to maintain transport for referrals
5. Inadequate supervision of health workers by Health Sub-District.
6. Poor data management

OPPORTUNITIES

1. Donor support
2. Good collaboration with community resource persons
3. Good collaboration with the NGOs
4. Good collaboration with the private not for profit units
5. Improved security
6. Good political support
7. Increased wage bill & funds for recruitment

THREATS

1. Low tax base in the district

2. NGOs closing office and some phasing out
3. Donor fatigue
4. Low will for volunteerism by the community
5. High expectations for facilitation by resource persons fuelling discontent
6. Moderate food insecurity
 7. High illiteracy rate

1.8 PRIORITY ACTIVITIES FOR FY 2011/12

To achieve our overall mission statement and objective, the following priorities
have been identified:

A. SUBCOUNTY PRIORITIES
These priorities have been captured from the subcounty priorities submitted
to the District planning unit. (Not all subcounties have submitted their
priorities.)

Subcounty Project
Project area Location
Atanga Construction of HCII Ngo-too Parish-
Construction of HCII Gojani Parish-Boroboro village
Construction of staff Lawiye-Adul HCII
houses
Completion of Lawiye- Lawiye-adul HCII
Adul HCII
Construction of HCII Kal Parish-Labongo guru vilage
Angagura Construction of HCII Pungole Parish-Laraba village
Laguti Construction of OPD- Lapyem parish-Lajeng village
Lajeng HCII
Construction of staff Lajeng village
house
Construction of Laguti HCIII-Namorembe village-lapyem parish
labortory
Fencing at Laguti HCIII Lapyem parish
Motorcycle for HA Laguti HCIII-Lapyem parish
Beds and other Laguti HCIII-Lapyem parish
equipment
Laguti Completion of Amilobo Lobut village-Paibwor parish
HCIII OPD
Construction of staff Lobut village-Paibwor parish
houses at Paibwor HC
II
Construction of 8 Amilobo HC II-Amilobo Central village
stances toilet
Construction of staff Paibwor HCII-Lobut village
 houses
Construction of 8 Paibwor HCII
stances toilet
Construction of staff Bira village
houses
Construction of Wilobo HCII-Bira village
maternity ward
Provision of beds Wipolo HCII-Bira village
Construction of Pakeyo Lokaloye A village
HCII OPD
Construction of latrines Wipolo & Pakeyo HCII
Lapul Construction of OPD Okworo
Construction of staff Alim HCII
quarters
Construction of staff Lapul HCIII-Koyo parish
quarters
Construction of pit Lapul HCIII-Koyo parish
latrines
Fencing HC Lapul HCIII
2 Staff Lawire HCII-Ato parish
quarters/retoling/fencing
Puranga Construction of OPD Laminocwida
parish,Aroinga,parwech,laminaciko,apur
Staffing Ogonyo,Oret
Construction of latrines Ogonyo,Oret
Provision of adequate Ogonyo, Oret
drugs
Provision of staff Oret, Ogonyo
quarters
Construction of Ogonyo, Oret
maternity ward
Kilak Construction of OPD 4 parishes
Construction of latrines All HCIIs
Provision of staff All HCIIs
quarters
Pader TC Construction of OPD All wards-Olwor central, Olwor North, Te-kituba,
Pagwari East, Pagwari West, Ogeng South,
Acoro, Olwor South, Lupwa South, Kiteny East,
Lupwa North, Obong bene, Lagwai East, Lutyek,
Lagwai zone A, Oloki-lee, Dog nam East, Te-
jingi, Dog nam, Te-oryang,
Extension of piped
water

B. DEPARTMENT PRIORITIES

1. Infrastructure
• Construction of staff houses, wards and upgrade HC IIs.
• Electrification of Health centers along the grid.
• Equip Health Centers
2. Revitalise immunisation services meet targets set by district/UNEPI by:
• Improving mobilization (community) and advocacy at all levels.
• Capacity building for community resource persons (vaccinators, CHWs,
Parish mobilisers)
• Increasing No. of static units and outreaches.
• Strengthening of cold chain management.
• Timely payment of allowances for outreaches.
• Strengthening of the surveillance system through improved monitoring of
indicators, assessment of performance and providing feedback to all levels.
• Providing more logistical support and ensuring a smooth supply of logistics
• Recognition of the best performers through prize giving.

3. Stepping up Reproductive Health interventions by:

• Recruit more midwives.
• Providing the necessary minimum required equipment for delivery
services.
• Strengthening referral system through providing bicycle ambulances,
vehicle and communication gadgets.
• Promotion of management of MIP (Malaria In Pregnancy).
• Initial training of fresh TBAs and re-training of Traditional Birth Attendants
(TBAs) in service
• In service training for midwives and other health workers.
• Establish adolescent friendly reproductive health services

4.Scaling up of Malaria control activities by:

• Promotion of the use of insecticide treated bed nets.
• Effective treatment of malaria in the H/units.
• Effective treatment of malaria at home by promotion of Home Based
Management of fevers using Community Based Resource Persons (CBRPs).
• Orienting staff on the rapid diagnostic test for malaria
• Indoor Residual Spraying in communities, schools, health units etc

5. Strengthening TB control efforts by:

• Implementing Communty Based-Directly Observed Treatment
Shortcourse(CB-DOTS)
• Supporting HSD TB focal persons
• Strengthening existing diagnostic and treatment centres
• Expansion of diagnostic and treatment centres to underserved areas
• Stepping up support supervision
• Ensuring a smooth supply of anti-TB drugs by accurate
quantification/forecasting
• Training of health workers on CB-DOTS
• Training of private practitioners on CB-DOTS
6. Scaling up of HIV/AIDS interventions by:
• Strengthening the PMTCT centres, VCT centres and Supporting VCT
outreaches
• Provision of ARVs
• Holding monthly co-ordination meetings
• Strengthen Support Supervision by facilitating HSD Supervisors
• Train health workers
• Sensitisation of communities on HIV/AIDS
• Supply of consumables
• Strengthening the district Laboratory network

7. Health Promotion and Education

• Promote community participation in health by strengthening the VHT
concept, and ensuring HUMCs are established and functional for all units
• Intensify health education, community dialogue to increase awareness
and promote behavior change

8. Nutrition
• Open up more Outpatient Therapetic sites and strengthen the Therapeutic
Feeding Centers.
• Train staff on management of acute malnutrition
• Conduct outreaches
• Ensure smooth flow of supplies
• Implement surveillance using technology for development initiative.

9. NTD
• Ensure smooth flow of supplies
• Support Community Medicine Distributors
• Conduct Mass Drud Administration.
• Surveillance for adverse reactions
• Environmental Health interventions
• Community Health education

10. Mental Health

• IEC for promoting mental health
• Capacity building
• Ensure a smooth drug and logistics supply system
• Avail case management guidelines

11. IDSR- Strengthen Integrated Disease Surveillance and Response by:

• Capacity building
• Purchase of data storage and analysis facilities and establish data
bases
 • Support weekly reporting of diseases of epidemic potential
• Purchase of communication equipment
• Strengthen and expand the laboratory network by purchasing
laboratory equipment and supplies

12. HMIS
• Installing ICT facilities at district and HSD levels.
• Capacity building on HMIS.
• Reward system for improving timeliness, completeness and data analysis.
• Provide quarterly feedback to all units.
• Provide adequate HMIS materials for all functional units

13. Sexual and Gender based Violence

• Data collection to quantify the extent of the situation.
• Capacity building and attitudinal change for care of the afflicted.
• Equipping units for case management.
• Community mobilization/IEC for the prevention and early referral of the
victims.
• Integration into mainstream reproductive health activities.

14. Drug Supply Chain Management(SCM)

• Supervision of SCM
• Build capacity for SCM at all levels
• Strengthen the MTCs

15. Capacity Building

• Provide In service and local training based on a capacity building plan.
• Strengthen Support supervision and on-job training.

1.9 CHALLENGES IN THE HEALTH SECTOR

1. Inadequate trained staff.

2. Inadequate staff housing.
3. Inadequate medicines and health supplies
4. Gaps in management positions at various levels of
service delivery.
5. Minimal community participation in health promotion.
6. High disease burden.
7. Ill equipped health facilities.
8. No funds for uniforms for health cadres.
9. Lack of financial and supervisory support from the
Health Sub-District to the health facilities.
10. Delays in processing funds in facilities to facilitate
service delivery and motivate vaccinators and parish
 mobilizers
11. A few mothers still visit ANC at 9 months so they are
unable to get 2 doses of Fansidar and all the services
offered at ANC.
12. Low male involvement in health programmes.
13. Inadequate sensitization on health programmes .
14. Maintenance of the referral system difficult due to
inadequate funding.
15. Essential drug stock outs especially anti-malarials.
16. Inadequate space for service delivery in some units.
17. Inadequate funding.

1.10 WAY FORWARD

1. Emphasis on consolidation of existing infrastructure by equipping,
expanding(more space and staff houses) and renovation.
2. Recruitment of more trained staff.
3. Strengthen supervision by conducting frequent spot checks and scheduled
visits
4. Promote health education through community dialogue, the media and drama.
5. Subcounty chiefs and subaccountants to facilitate access to funds by units.
6. Equip units through the credit line by the Ministry of Health.
7. Management training for in-charges.
8. Allocation of funds in the health units will be based on performance, workload,
staffing and responsibilities.
9. Funds be allocated for maintenance of the eferral system.