1. 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,

2. 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

3. Background 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

4. Background (II) 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”

5. Problem Statement & Justification 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

6. Objectives 1.To determine the geographic and skill mix distribution of qualified health workers in Uganda 2.To identify the current efforts to improve the quality of available information on the distribution of health workers 3.To determine the level of integration of data on the distribution of health workers 4.To identify the successes and challenges of producing high quality information on the distribution of health workers

7. Methodology (II) 1.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 2.In-depth Interviews: – MOH (Personnel Department, Resource Centre) – 3 Faith-based medical bureaux – NGO (Capacity Project/IntraHealth)

8. Findings (I) - Geographical and Skill Mix Distribution 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

9. Findings (II) – Geographical and Skill Mix Distribution Source: MOH Uganda and IntraHealth, 2010: Human Resources for Health Audit Report 2010

10. Findings (III) – Efforts to Improve Quality of Information 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)

11. Findings (IV) – Quality of Information OwnerHospitals Lower Levels Content MOH√√ Numbers, qualifications, vacancies FBB – Catholic √√ Numbers, qualifications, vacancies FBB – Protestant √Some Numbers, qualifications, vacancies FBB - Muslim√SomeNumbers, qualifications, vacancies Only MOH database attempts a geographical analysis No database analyses health-worker skills

12. Findings (V) – Database Linkage and Integration Government health facility District levelMOH HRIS National HRH Database Diocese level District level Protestant health facility Muslim health facility Catholic health facility UPMB HRH Database UCMB HRH Database Private health facility District level National Private Practitioners HRH Database UMMB HRH Database Traditional Medicine practitioner District levelNational level Traditional Medicine HRH Database Key Red /dashed= lacking structure or link

13. Findings (VI) – Database Linkage and Integration 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

14. Findings (VII) – Successes & Opportunities 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

15. Findings (VII) – Challenges & Threats 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

16. Findings (VIII) – Challenges & Threats 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)

17. Discussion 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

18. Recommendations 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