1. Health Sector Strategic Plan II TRM May 27 th – 29 th 2008 The CSOs Views Uganda’s Health Systems during HSSP II Dr. Sam Orochi Orach Asst. Executive Secretary Uganda Catholic Medical Bureau

2. A weak system under increasing pressure Inflamed SYSTEM Unbalanced inhomogeneous weakened Public Sector Civil society 1.Weak Human Resource Number (Absolute / functional) Migration Discipline and ethics Absenteeism ( Physical / functional) Source of motivation????? Source of job security – Performance????????? 1.Weak Corporate Governance 2.Weak management 3.SWAp & PPPH need strengthening 4.Poor Coordination & Supervision 5.Compliance with HSSP II ????? 6.Poor management and use of Information (HMI) – various levels 7.Too many guidelines (317) 8.Negative effects of Vertical Programs on systems 9.Functionality of HSD ??? Overweighed by UMHCP + ARV+ ? +

3. What CSOs bring along to HSSP II Output to the HSSP II 75% of PNFPs (3 bureaus) alone contribute about 30% -40% (HSSP II output, HRH, Hospital beds and infrastructure etc) Experience and skills and to share Innovation Resources Financial HRH Infrastructure Access to remote communities and wide coverage - esp. the facility-based PNFPs

4. What do CSOs want to see Practical steps to improve governance and management Not only at MoH HQ but down along the whole column Biggest focus should be at district & facility levels Leadership & Management by people trained for the job Positive encouragement of the role of the citizenry in providing care Recognition of partners / CSOs as components of THE system and not conditional guests Roles of CSOs be objectively brought out to public knowledge Practical steps to make the SWAp structures and processes functional

5. What CSOs want to see II Streamlined partnership based on the vision, purpose, strategy and presence on the ground Clear plan for formalization of relationships in PPPH – all levels PPPH should not depend on interpretation and will / interest of individual managers Quantifying contribution of all partners / CSOs towards HSSP II Ensure all partners / CSOs in health work within HSSP II? Resources available to the NATION producing more and better through use by all genuine partners in a well distributed and efficient manner Improved support to facility-based PNFP

6. What CSOs want to see “There is no free lunch” Adequate and appropriate Health system financing Support to CSOs incl. PNFP is an efficient investment Any pressure to increase targets / scale up must be preceded by pressure and willingness to increase funding to the systems component Analysis be made on intended interventions or scale ups for their possible impacts on systems Hospitals to have business plans is not enough Need to have services costed to avoid wrong expectations Policies and guidelines be made functional and harmonized Not only targets be revised downwards but also systems strengthening plan drawn to improve performance Tools to assess the assess functionality of HSDs