What is the money given to a specific health facility spent on? What about the trends in antenatal care?
In Eastern Uganda, health facilities in the districts of Pallisa, Kamuli and Kibuku were struggling to find answers to these questions. They were so overwhelmed with simply delivering the necessary health services that, in many cases, the management systems required to be able to answer such questions were lacking.
To improve this situation, the Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study run by the Makerere University School of Public Health (MakSPH), which is funded jointly by the UK charity Comic Relief and the UK Government via the Future Health Systems research consortium, launched a management training programme for health workers in these districts.
The initiative is set to fund over 60 health workers in the three districts. The first group of 30, ten from each district graduated in April, just as another group of 30 enrolled for a certificate course in health services management at MakSPH.
And already, facilities in these districts have started registering successes from these trainings.
Testimonies from the beneficiaries indicate that funding these trainings has been an invaluable investment.
Stephen Otukor, In-charge at the Kasodo Health Centre III - Pallisa
“When I look back, I realise that course helped me solve some critical issues that were affecting work at the health facility. I realised that financial management needed to be addressed. One of the issues was transparency – where staff members wanted to know what was in the facility and how it is spent. The skills from the course helped me so much to address that problem. Every staff now knows what it [the funding] is supposed to do, what we receive at the facility, and how we spend that money within the facility.
"The other good thing is that when we collect the data nowadays, we analyse it, and we utilise it. This has helped us in decision making, for instance if we plot a graph, maybe of antenatal care for a whole financial year and find problems, we track the root causes of why some areas have low coverage and why other areas have more [users of the facility]. We then find solutions to the challenges.”
Ms Edith Bogere, Senior Nursing Officer, Kamuli General Hospital
“Previously we have been conducting support supervision. But the same problems kept occurring in Bupadhengo Health Centre III, and we could not get things changed. During the training at MakSPH, we were able to plan better our supervision, involving the in-charge of the health facility, and we were able to discuss together with the facility staff to find solutions.
"This was not the case before because our supervision was not well coordinated. It was like policing and that kind of thing, and blaming all the time. But this time round, using skills from the course, we were able to involve and work as a team from the health sub-district, the district and the health facility. The in-charge gave us her views and one of them was to change a midwife that was there to another health facility and get her another one or two. The DHMT (District Health Management Team) respected her opinion.
"Right now as we speak, we have seen deliveries increasing in this facility, even the out-patient attendances are improving. Now, when you compare the [health management report] of Bupadhengo and those before you see a marked improvement. This is simply because we were able to change our approach of supervision and problem solving.”
Words of wisdom
Prof. Freddie Ssengooba, the incoming head of the department of health policy planning and management at MakSPH, spoke at the certificate ceremony. He observed that, while health workers do a commendable job, they were not perfect beings and could always improve.
“If you went through a course like this and you did not improve, there is a problem. Please use these skills to ensure that the people or organisations you work with are all improving.”
Prof. Ssengooba also asked the health workers to use the acquired knowledge to improve their communication skills and community relations.