Monitoring and Evaluation Plan for Implementation of the

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THE REPUBLIC OF UGANDA

MINISTRY OF HEALTH

Monitoring and Evaluation Plan for

Implementation of the

Health Sector Development Plan

2015/16 - 2019/20

May 2016

Any part of this document may be freely reviewed, quoted, reproduced or translated in full or in part, provided the source is acknowledged. It may not be sold or used in conjunction with commercial purposes or for profit. Government of Uganda, Ministry of Health: Monitoring & Evaluation Plan for the Health Sector Development Plan, 2015/16 – 2019/20. Published by: Ministry of Health PO Box 7272 Kampala, Uganda Email: [email protected] Website: www.health.go.ug

mailto:[email protected]

http://www.health.go.ug/

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Table of Contents

TABLE OF CONTENTS .......................................................................................................................................III

ACRONYMS ..................................................................................................................................................... V

DEFINITIONS ................................................................................................................................................. VII

FOREWORD ..................................................................................................................................................... 8

ACKNOWLEDGEMENTS .................................................................................................................................... 9

EXECUTIVE SUMMARY ................................................................................................................................... 10

1 INTRODUCTION ..................................................................................................................................... 12

1.1 GOALS AND OBJECTIVES OF THE HSDP 2015/16 - 2019/20 ........................................................................... 12

1.2 GOAL AND OBJECTIVES OF THE M&E PLAN FOR THE HSDP.............................................................................. 13

1.3 SITUATIONAL ANALYSIS OF THE M&E PRACTICES AND MECHANISM .................................................................... 13

1.4 PROCESS FOR DEVELOPMENT OF THE M&E PLAN ........................................................................................... 16

1.5 DISEASE AND PROGRAM SPECIFIC M&E ALIGNMENT ....................................................................................... 17

2 INSTITUTIONAL CAPACITY ..................................................................................................................... 18

2.1 M&E COORDINATION MECHANISMS ........................................................................................................... 19

2.2 ROLES AND RESPONSIBILITIES ..................................................................................................................... 20

2.3 CAPACITY BUILDING STRATEGY ................................................................................................................... 26

3 MONITORING AND EVALUATION FRAMEWORK .................................................................................... 28

3.1 THE M&E FRAMEWORK ............................................................................................................................ 28

3.2 M&E EVENTS ......................................................................................................................................... 29

3.3 INDICATORS ............................................................................................................................................ 29

3.4 DATA SOURCES ........................................................................................................................................ 36

3.5 DATA MANAGEMENT ................................................................................................................................ 37

3.6 DATA DISSEMINATION AND USE ................................................................................................................... 44

3.7 EVALUATION ........................................................................................................................................... 45

3.8 SURVEYS AND SURVEILLANCE ...................................................................................................................... 46

4 PROGRESS AND PERFORMANCE REVIEWS ............................................................................................. 48

4.1 PROGRESS REVIEW ................................................................................................................................... 50

4.2 ANNUAL REVIEW ...................................................................................................................................... 52

4.3 MID TERM REVIEW .................................................................................................................................. 53

4.4 END TERM REVIEW .................................................................................................................................. 53

4.5 LINKAGES BETWEEN HEALTH SECTOR REVIEWS, PROGRAM / PROJECT SPECIFIC REVIEWS, AND GLOBAL REPORTING ....... 54

4.6 DECISION-MAKING PROCESSES AND TOOLS FOR REMEDIAL ACTION ..................................................................... 55

5 IMPLEMENTATION PLAN ....................................................................................................................... 56

6 MONITORING THE IMPLEMENTATION OF THE M&E PLAN FOR THE HSDP ............................................. 58

6.1 M&E PLAN IMPLEMENTATION MONITORING INDICATORS ............................................................................... 59

7 BUDGET ................................................................................................................................................. 60

8 ANNEX ...................................................................................................................................................... I

8.1 QUARTERLY OUTPUT REPORT FORMAT FOR THE WORKPLANS & BUDGETS ............................................................. I

8.2 DETAILED 5 YEAR BUDGET FOR IMPLEMENTATION OF THE PLAN ........................................................................... I

8.3 DISTRICT LEAGUE TABLE INDICATORS ............................................................................................................ IV

8.4 INDICATOR DEFINITIONS FOR THE HSDP KEY PERFORMANCE INDICATORS ............................................................. V

8.5 INDICATOR DEFINITIONS FOR THE ADDITIONAL INDICATORS IN THE DLT ............................................................ XXII

8.6 CYP CONVERSION FACTORS .................................................................................................................... XXIV

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Acronyms AHSPR Annual Health Sector Performance Report

BFP Budget Framework Paper

CAO Chief Administrative Officer

CCM Country Coordinating Mechanism

CHeSS Country Health Systems Surveillance

CHMIS Community Health Management Information System

CHEW Community Health Extension Worker

CPD Continuous Professional Development

CSO Civil Society Organisation

DHIS District Health Information System

DHMT District Health Management Team

DHO District Health Office

DHT District Health Team

DQA Data Quality Assessment

DQAA Data Quality Assessment and Adjustment

GAVI Global Alliance for Vaccines and Immunisation

GoU Government of Uganda

HC Health Center

HDP Health Development Partners

HID Health Information Division

HMIS Health Management Information System

HRIS Human Resource Information System

HSD Health Sub-District

HSDP Health Sector Development Plan

HSSIP Health Sector Strategic and Investment Plan

HPAC Health Policy Advisory Committee

HUMC Health Unit Management Committee

ICD International Classification of Diseases

ICT Information and Communication Technology

IFMS Integrated Financial Management System

IHP+ International Health Partnerships and related Initiatives

IDSR Integrated Disease Surveillance and Response

JAF Joint Assessment Framework

JRM Joint Review Mission

KM Knowledge Management

LC Local Council

LG Local Government

MDAs Ministries, Departments and Agencies

MDGs Millennium Development Goals

MPS Ministerial Policy Statement

M&E Monitoring and Evaluation

MoH Ministry of Health

MoFPED Ministry of Finance, Planning and Economic Development

MoLG Ministry of Local Government

MTR Mid Term Review

NCD Non-Communicable Diseases

NDP National Development Plan

NHA National Health Accounts

NHP National Health Policy

NIRA National Identification & Registration Authority

NSDS National Service Delivery Survey

NMS National Medical Stores

NPA National Planning Authority

NRH National Referral Hospital

OBT Output Budgeting Tool

OPM Office of the Prime Minister

PHP Private Health Practitioners

PNFP Private-Not-For-Profit Organizations

QAD Quality Assurance Department

RPMT Regional Performance Monitoring Team

RRH Regional Referral Hospital

SCMS Supply Chain Management System

SDG Sustainable Development Goal

SMC Senior Management Committee

SME&R Supervision, Monitoring, Evaluation and Research

SOP Standard Operating Procedure

SWAp Sector Wide Approach

TWG Technical Working Group

UBOS Uganda Bureau of Statistics

UDHS Uganda Demographic Health Survey

UNHRO Uganda National Health Research Organisation

UNPS Uganda National Panel Survey

VHT Village Health Team

WHO World Health Organisation

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Definitions

Civil Society Organization Is the aggregate of non-governmental organizations and institutions

that manifest interests and will of citizens.

Data Management Comprises all processes related to data collection, analysis,

synthesis and dissemination.

Data Quality Assurance Is the process of profiling the data to discover inconsistencies and

other anomalies in the data, as well as performing data cleansing

activities (e.g. removing outliers, missing data interpolation) to

improve the data quality.

Evaluation Rigorous, science-based analysis of information about program

activities, characteristics, outcomes and impact that determines the

merit or worth of a specific program or intervention.

IHP+ Is a group of partners who share a common interest in improving

health services and health outcomes by putting the principles of the

Paris Declaration on Aid Effectiveness into practice.

Impact Fundamental intended or unintended changes in the conditions of

the target group, population, system or organization.

Knowledge Management Is a set of principles, tools and practices that enable people to create

knowledge, and to share, translate and apply what they know to

create value and improve effectiveness.

Monitoring The routine tracking, analysis and reporting of priority information

about a program and its intended outputs and outcomes.

Outcome Actual or intended changes in use, satisfaction levels or behaviour

that a planned intervention seeks to support.

Performance The extent to which relevance, effectiveness, efficiency, economy,

sustainability and impact (expected and unexpected) are achieved

by an initiative, program or policy.

Review Organizational processes for assessing health systems progress and

performance.

Foreword The Ministry of Health launched the Health Sector Development Plan 2015/16 – 2019/20

which defines the medium term health agenda and operationalize Uganda’s aspirations as

outlined in the second National Development Plan. The goal of this Monitoring & Evaluation

(M&E) Plan is to contribute to the attainment of the HSDP 2015/16 - 2019/20 goal,

objectives and performance targets by providing a health sector-wide framework for regular

and systematic tracking and documenting progress in the health sector performance.

The development of M&E Plan for HSDP 2015/16 – 2019/20 has been largely informed by

lessons from the Mid Term Review of the Health Sector Strategic and Investment Plan

(HSSIP) 2010/11 - 2014/15 in addition to a rapid assessment conducted to provide insight

into the current M&E practices and mechanisms. The process of development of this plan was

highly consultative, participatory and transparent. The Supervision Monitoring Evaluation

& Research Technical Working Group comprising of MoH officials, Health Development

Partners, Civil Society, UBOS, Medical Bureaus, private sector and academia was responsible

for overseeing the development of the M&E plan.

It is envisaged that this comprehensive M&E plan to which all health partners subscribe

under the IHP+ arrangements, shall be the basis for improving the quality of routine

information systems and be used to institutionalize mechanisms and tools for measuring

quality of both facility and community based services. It should also strengthen dissemination

and use of information at national, sub national and global levels.

I wish to express my appreciation to all of you who worked tirelessly to develop the M&E

Plan for HSDP on behalf of the people of Uganda. I look forward to the acceleration of the

implementation of this Plan and hold each other accountable for the resources provided for

implementation of the HSDP.

For God and My Country

Dr. Jane Ruth Aceng

MINISTER OF HEALTH

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Acknowledgements

The Ministry of Health would like to express its appreciation to all key stakeholders who

supported the process of developing this Monitoring & Evaluation Plan for Implementation

of the Health Sector Development Plan (HSDP) 2015/16 - 2019/20 through technical and

financial support. The development process was consultative covering a wide range of

stakeholders at national and sub-national levels including private and public sectors.

The funding for the development of this plan was generously supported by Government of

Uganda, the WHO Country Office and the USAID Monitoring and Evaluation Technical

Support (METS) Project under the School of Public Health.

Special thanks go to the Ministry of Health Quality Assurance Department for taking the

lead in reviewing and developing this plan and the Supervision, Monitoring, Evaluation and

Research Technical Working Group for the valuable input.

All stakeholders in the health sector are thus encouraged to make use of this valuable

document to keep track of the implementation of the HSDP and make overall contribution to

the attainment of Universal Health Coverage goals.

Prof. Anthony Mbonye

AG. DIRECTOR GENERAL HEALTH SERVICES

Executive Summary The M&E Plan for the HSDP 2015/2016 – 2019/20 has been developed to operationalize the strategic

orientation provided for comprehensive M&E in HSDP 2015/2016 – 2019/20. It focuses on the main

M&E activities and aligns them to the existing national and international structures and frameworks.

This Plan describes the M&E framework, indicators, processes, sources of data, methods and tools

that the sector will use to collect, compile, report and use data, and provide feed-back as part of the

national Health Sector M&E mechanisms. It is intended to document what needs to be monitored,

with whom, by whom, when, how, and how the M&E data will be used. It also outlines how and when

the different types of studies and evaluations will be conducted by the sector. It translates these

processes into annualized and costed activities, and assigns responsibilities for implementation.

The specific objectives of the M&E Plan for the HSDP are;

1. To define mechanisms for assessment of the health sector performance in accordance with the

agreed objectives, performance indicators and reporting timelines for the HSDP.

2. To support management for results through evidence based decision-making, policy development

and advocacy; sector learning and improvement at all levels during implementation of the HSDP.

3. To enhance compliance with government policies (accountability), and constructive engagement

with stakeholders (policy dialogue) in the health sector.

4. To build capacity of the health sector to generate quality data and track progress of


5. To facilitate continuous learning (document and share the challenges and lessons learnt) at all

levels during implementation of the HSDP.

A review of a wide range of national and health sector documents was done to provide in-depth

analysis and understanding of the sector M&E system; such as NDP II M&E Strategy, NHP II, M&E Plan

for the HSSIP 2010/11 – 2014/15, HSDP 2015/16 - 2019/20, Program specific M&E plans and the

Health Management Information System (HMIS) Manual, among others.

The sector-wide M&E system for effective tracking, evaluation and feedback on HSDP implementation

and results will be followed as defined in the NDP II M&E Strategy. This implies that Central

Government, MoH, LGs, HDPs, CSOs and other stakeholders will be involved directly or indirectly in

the M&E activities. The relevant institutions shall ensure availability of adequate skilled human

resources in all aspects of M&E at all levels. To ensure this, the sector shall develop/improve M&E

human resource capacity through training, providing guidelines and tools, supportive supervision and

mentoring.

The health sector shall apply the IHP+ common M&E Framework which provides a logical and results-

chain representation of the key components of the HSDP M&E. It comprises four major indicator

categories: system input and processes, outputs, outcomes, and impact (Figure 2). 41 key

performance indicators (see Table 3) were identified based on the priority diseases and the health

systems components addressed in the HSDP.

Specific programs and projects have their own strategic and operational plans that are more detailed

than the HSDP. They are also expected to develop specific program / project M&E Plans which will

include more indicators to measure process, outputs and immediate outcomes. These should

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however, be aligned with the goal, objectives and strategic interventions of the HSDP to demonstrate

the effects of health system strengthening to health outcomes.

Special focus will be on the data management practices namely; collection, validation, feedback,

analysis / synthesis, dissemination and use. Specific efforts will be made to undertake Data Quality

Audits and routine (quarterly) data on a sample of districts among others. Regular data verification for

facility based data for accuracy and completeness will be carried out at least monthly by the health

facility in-charges. Data analysis and synthesis will be done at all levels (national, sub-national to

community) to enhance evidence-based decision-making. All relevant data will be synthesized based

on determined parameters (disaggregated) where applicable and analyzed for use at various levels of

the sector. Regular reporting using the HMIS and other sources of data will be used to generate

relevant information at all levels. The analytical reports will provide information for decision-making,

program management, financial disbursements and global reporting.

The health sector will undertake evaluation of the overall HSDP implementation as well as evaluation

of specific programs, projects, policies and interventions. The type of evaluation to be planned for and

conducted should reflect the nature and scope of the public investment.

During this HSDP period the following major surveys are planned; the UDHS-16, AIDS Behavioral

Survey, National Health Accounts and efficiency analyses. Each program will identify and include all

surveys to be conducted in the respective M&E Plans. Health Institutions are encouraged to conduct

operational research. Operational surveys shall be carried as planned on approval by the relevant

institutions and findings disseminated through the existing structures.

The HSDP monitoring and review process will be interlinked across the different planning entities. All

reviews will be presented and endorsed at the respective management and partnership structures for

the level. The outcomes of the review process will be used to guide decision making during planning,

resource mobilisation and allocation, accountability, policy dialogue, review and development.

Global reporting requirements shall be based on ongoing country processes. The common M&E

platform (See Figure 6) serves as the guide for all M&E related processes such as the health sector

component of the Sector Wide Approaches (SWAp) and IHP+, for program activities supported by

Global Funding Agencies e.g. GAVI, the Global Fund for TB, AIDs and Malaria, and other DPs, and for

disease and program / project specific needs.

Over the 5-year period, an estimated total of UGX 89,653,447,000/- will be required for

implementation of this plan. Of this 35.4% is required for compilation and submission of performance

reports, 31.5% for performance reviews and 23% for surveys (Table 8).

The implementation plan is annualized for the key M&E activities, showing the responsible persons or

departments and frequency of the activities (Table 7).

1 Introduction

The purpose of the sector Monitoring and Evaluation (M&E) system is to coordinate and support the

Ministry of Health (MoH), related Ministries, Health Development Partners (HDPs), Local

Governments (LGs) and stakeholders to regularly and systematically track progress of implementation

of priority interventions of the sector plans and assess performance of the sector and LGs in

accordance with the agreed objectives and performance indicators over the Medium Term (output,

outcome and impact monitoring). In order to do this there is need for an M&E system that provides

timely and accurate information to government and partners in order to inform performance reviews,

policy discussions and periodic revisions to the national strategic and operational plans.

The health sector carries out three types of monitoring which address different stages in the results

chain, namely;

(i) Financial implementation monitoring addresses whether or not budgets have been released

and spent in line with allocations;

(ii) Physical implementation monitoring addresses whether activities have taken place in line

with targets; and

(iii) Outputs, outcome and impact monitoring trace whether or not results are occurring

amongst the target population.

The M&E Plan for the Health Sector Development Plan (HSDP) 2015/2016 – 2019/20 has been

developed to operationalize the strategic orientation provided for comprehensive M&E in

HSDP2015/2016 – 2019/20. It focuses on the main M&E activities and aligns them to the existing

national and international structures and frameworks.

This Plan describes the M&E framework, indicators, processes, sources of data, methods and tools

that the sector will use to collect, compile, report and use data, and provide feed-back as part of the

national Health Sector M&E mechanisms. It is intended to document what needs to be monitored,

with whom, by whom, when, how, and how the M&E data will be used. It also outlines how and when

the different types of studies and evaluations will be conducted by the sector. It translates these

processes into annualized and costed activities, and assigns responsibilities for implementation.

1.1 Goals and objectives of the HSDP 2015/16 - 2019/20

1.1.1 Goal

To accelerate movement towards Universal Health Coverage (UHC) with essential health and related

services needed for promotion of a healthy and productive life.

This goal will be achieved through a focus on the following specific objectives.

1.1.2 Objectives

1) To contribute to the production of a healthy human capital for wealth creation through provision

of equitable, safe and sustainable health services.

2) To increase financial risk protection of households against impoverishment due to health

expenditures.

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3) To address the key determinants of health through strengthening inter-sectoral collaboration and

partnerships.

4) To enhance health sector competitiveness in the region and globally.

1.2 Goal and Objectives of the M&E Plan for the HSDP

1.2.1 Goal

The goal of this M&E Plan is to contribute to the attainment of the HSDP 2015/16 - 2019/20 objectives

and performance targets by providing a health sector-wide framework for regular and systematic

tracking and documenting progress in the health sector performance.

1.2.2 Specific Objectives

The specific objectives are;

1. To define mechanisms for assessment of the health sector performance in accordance with the

agreed objectives, performance indicators and reporting timelines for the HSDP.

2. To support management for results through evidence based decision-making, policy development

and advocacy; sector learning and improvement at all levels during implementation of the HSDP.

3. To enhance compliance with government policies (accountability), and constructive engagement

with stakeholders (policy dialogue) in the health sector.

4. To build capacity of the health sector to generate quality data and track progress of


5. To facilitate continuous learning (document and share the challenges and lessons learnt) at all

levels during implementation of the HSDP.

1.2.3 Outcomes

This M&E Plan should result in:

i) Timely reporting on progress of implementation of the HSDP

ii) Objective evidence based decision making for performance improvement, planning, resource

allocation, policy development and advocacy.

iii) Timely accountability to government and stakeholders.

iv) Competent and well equipped human resource for M&E.

v) Documentation and sharing of results and lessons learnt.

1.3 Situational Analysis of the M&E practices and mechanism The M&E Plan for HSSIP 2010/11 – 2014/15 was developed and disseminated aiming at establishing

an M&E system that is robust, comprehensive, fully integrated, harmonized and well coordinated

to guide monitoring of the implementation of the HSSIP and evaluate impact. This resulted in a

Country-led M&E Platform especially in the use of harmonized data collection tools and reporting

system. With health information, research and evidence generation, the country was able to

transition to the District Health Information System (DHIS)-2, which is an electronic web based

reporting mechanism and also revised the HMIS reporting tools to ensure information

disaggregation. A Data Quality Assessment (DQA) manual and harmonized DQA tools were

developed. Surveys and facility assessments specific for some high burden conditions (HIV, TB

prevalence, malaria, NCDs, etc) were successfully initiated / conducted (HSDP MoH 2015). During the

HSSIP period, timeliness of HMIS monthly reporting by the districts increased from 77% in 2010/11

to 88% in 2014/15; and completeness of facility reporting increased from 85% in 2010/11 to 96%

(AHSPR 2014/15, MoH).

E-health has become a stronger area of focus, with the national e-health technology framework

completed and draft e-Health policy developed. The Government has maintained strong stewardship

over this developing area, to ensure the emerging e-health architecture is aligned to the pillars of the

e-health house of value.

With support from the Global Fund for TB, HIV/AIDs and Malaria (GFTAM), 12 Regional Performance

Monitoring Teams were established to strengthen the decentralized capacity for active performance

monitoring and surveillance of program outputs and support the performance management of

implementing agencies at all levels. A Health Facility and community feedback mechanism i.e. mTRAC

exists and has been rolled in all the 112 districts. However, UNICEF has also been able to roll out the

U- report-which is also a community feedback mechanism. On annual basis Annual Health Sector

Performance Reports were compiled and disseminated. Annual Sector Performance Reviews were

conducted in addition to biannual reviews at national level. Quarterly performance reviews were

conducted at sub-national levels. Program review conducted for Malaria Program in 2011, TB

program in 2013 and HIV/AIDS program review to be conducted in 2015 (HSDP, MoH 2015). The MoH

also undertook a Mid-Term review of the HSSIP and the findings were used to inform the planning

process in the subsequent years as well as inform the development of the HSDP.

The M&E Structure for the MoH is not defined to streamline the M&E functions at national level. Weak

linkages between MoH and UBOS leading to poor timing in provision of results for guiding sector

planning. There is also lack of annual vital statistics on births and deaths. The sector has made progress

towards aligning the previously fragmented information systems within the health sector to ensure

contribution to the one M&E system.

The inadequate supply of the revised HMIS tools in all facilities is still hampering data collection and

reporting which compromises the data quality. There is still a challenge in the generation, compilation

and submission of programmatic and departmental reports that are expected to feed into the overall

sector performance reports. There are still irregular program and sub-national performance reviews

due to inadequate funds. Evaluations for most programs not conducted due to inadequate funding

and as a result impact of interventions is not well documented. The low reporting rates from the

private sector limits the ability to appropriately monitor overall sector outcome performance. Finally,

the utilization of data for decision-making is still minimal and technical guidance and coordination

needs to be given and enforced from the MoH to the lower levels and Partners (HSDP, MoH 2015).

The reliable collection of Civil Registration information and its accurate and timely processing into

Vital Statistics is critical to Government planning for the provision of social services. By December

2014, the Civil Registration and Vital Statistics (CVRS) was operational in 135 Government, Missionary

and Industrial hospitals country wide to record births in hospitals, 62 sub counties and 5 divisions

within Kampala Capital City Authority (KCCA) to record births in communities. Operators of this system

have been trained and equipped with registration equipment and materials. (Uganda National

Assessment on CRVS, UBOS 2014)

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The national assessment revealed that whereas people are knowledgeable about birth and death

registration, they seldom register birth and death, except when a birth or death certificate is needed

as a requirement to access a certain service. It was further established that the majority of the duty

bearers who are charged with registration of births and deaths do not consider making birth and death

registration returns as an important issue. The Country lacks a policy on BDR which makes it difficult

to enforce the BDR Act.

Further review of the M&E Plan for implementation of the HSSIP 2010/11 - 2014/15 was undertaken

to inform the development of this plan using the WHO Accountability Assessment Framework. The

objective of the assessment was to ensure that the HSDP M&E Plan practices and mechanisms are

appropriate to the country needs and that the plan will have wide ownership and commitment. This

was through identification of the strengths and weaknesses in the country M&E system, including

identification of the major actions required to address the gaps and needs.

Overall, there was compliance of the M&E plan for the HSSIP 2010/11-2015/15 basing on the WHO

Accountability Assessment Framework.

The key gaps identified using the WHO Accountability Assessment Framework are outlined below:

1) The baseline information for most of the impact indicators and other population based data

indicators for the HSSIP is not available to provide the current baseline or progress during the

HSSIP period. This information is obtained from the Uganda Demographic and Household

Survey (UDHS), which takes place every five years. It was noted that baseline information for

these impact indicators for the current strategic planning period would only be available

between December 2016 and March 2017.

2) The level of disaggregation (gender, age category, literacy, poverty, region) is not routinely

built into the analysis of the core set of indicators. Although some of the latter (age, sex,

region) are well captured in the HMIS and population-based surveys e.g. UDHS, it was noted

that the data users (programs) do not regularly demand for disaggregated data from the

Resource Center.

3) The M&E Plan specified the related costs for the Plan but many important areas remained

unfunded. There was some off-budget support had been obtained for some of these unfunded

areas but that this information had not been subsequently captured.

4) The main Human Resource (HR) challenge is the absence of an HR structure for M&E at the

MoH even though a submission to redress this was made to the Ministry of Public Service

(MoPS). So far there are only scattered uncoordinated efforts that have nevertheless enabled

recruitment of a few staff. There is still need for skills development for M&E.

5) There is an unclear process for setting and reviewing annual targets. For example, during the

drafting of the M&E plan for the HSSIP, Program Managers made their submissions to

Supervision Monitoring Evaluation & Research Technical Working Group (SMER TWG) and

there was no balance between the expected resources and targets being set leading to

underperformance against a number of indicators. However, there is a process to review some

of the key sector performance indicators that are reported to the Office of the Prime Minister

(OPM) annually.

6) There is a small task force under the Country Information and Accountability Framework

(COIA) Taskforce working on vital statistics with representation from the SMER TWG. However

there is a weak linkage between the MoH and the National Identification & Registration

Authority (NIRA), which undermines opportunities for strengthening the institutional linkage

between the MoH and the Ministry of Justice and Constitutional Affairs.

7) Disease burden among adults is summarized as broad categories – non-

communicable/communicable largely because there is weak diagnostic capacity at lower

levels e.g. the Hospital Census shows that only 13 out of 335 facilities are using the

International Classification of Diseases (ICD) 10 classification.

1.3.1 Recommendations

Prioritisation of provision of HMIS data collection tools at all levels including the private sector.

Include the levels / categories of disaggregation for all core indicators in the indicator definition

manual.

The impact indicator baselines should be updated as soon as information becomes available, if

possible during the Mid-Term Review (MTR) of the HSDP. The related targets and strategies should

be revised at the time of updating the baseline information.

SMER TWG to develop and disseminate the process for adjusting indicator targets and streamline

the commitment of targets with actual resources at least once during the MTR.

Ensure data synthesis and analysis based on disaggregated data and support skills strengthening

for this process at all levels. Sub-national analyses of the already available HMIS data as well as

the population-based survey results could identify challenged regions or sub-populations

deserving more targeted approach for achieving higher impact.

Linkage of the Human Resource Information System (HRIS), and Supply Chain management system

and other Health Information Systems to the DHIS 2 for better management.

Strengthen coordination of existing M&E human resource and activities at all levels for provision

of timely and accurate information, effective use of statistical data and health research at all levels

is a critical issue that can impact successful implementation of the HSDP.

Strengthen partner coordination for support and reporting through regular partner meetings and

joint planning.

Strengthen linkages and coordination between MoH and key partners e.g. UBOS, NIRA to address

the MoH data needs in a timely manner.

Institutionalization of the ICD 10 at all levels.

1.4 Process for development of the M&E Plan The SME&R TWG comprising of MoH officials, HDPs, Civil Society, UBOS, Medical Bureaus, private

sector and academia was responsible for overseeing the development of the HSDP M&E plan. A Task

Force was formed which worked in close collaboration with all relevant stakeholders in the

development process. This was in conjunction with the development of the HSDP and took into

consideration the NDP II M&E Strategy and HSDP requirements, as well as international treaties and

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conventions to which Uganda is a signatory more especially the Global Health Development Agenda

including the Sustainable Development Goals (SDGs) and the International Health Partnerships and

related Initiatives (IHP+) which seek to achieve better health results and provide a framework for

increased aid effectiveness; among others.

A review of a wide range of national and health sector documents was done to provide in-depth

analysis and understanding of the sector M&E system; such as NDP II M&E Strategy, NHP II, M&E Plan

for the HSSIP 2010/11 – 2014/15, HSDP 2015/16 - 2019/20, Program specific M&E plans and the

Health Management Information System (HMIS) Manual, among others. The aim of the document

review was to harmonize this Plan with the other government and inter-sectoral M&E Plans.

A rapid assessment of the HSSIP M&E Plan was conducted to provide insight into the current M&E

practices and mechanisms as well as insight into the unfinished agenda from the previous strategic

period and the reasons for this. The findings were used to guide the development of this plan. The

findings were presented and discussed in the SMER TWG and were used to enrich the Plan. A national

stakeholders meeting was conducted to obtain consensus on the plan. The involvement of the

different stakeholders was important in order to ensure transparency and ownership of the Plan. The

final draft was presented to the MoH Senior Management Committee for input and finally to the

Health Policy Advisory Committee (HPAC) for approval.

1.5 Disease and program specific M&E alignment Development of program and project specific M&E plans is a requirement for institutions, programs

and projects. Under the country-led platform operationalized during the last five years it is a

requirement for programs and projects to develop M&E plans aligned to the national strategy M&E

plan. All disease and program specific M&E Plans will use the same technical framework and M&E

platform defined in the HSDP M&E Plan.

The sector will also use a common platform for household surveys, facility assessments and

evaluations. This implies that data collection, aggregation, transfer and analysis are all coordinated

under the national M&E system.

Performance monitoring and review by institutions, programs and projects shall be based on the

institutional, program or project specific indicators in the respective M&E plans.

2 Institutional Capacity Chapter two outlines the institutional environment defining the coordination mechanisms, roles and

responsibilities for the different stakeholders and capacity building strategy. The health sector should

ensure availability of sufficient funding and financial management capacity as well as human resources

with adequate technical capacity to manage the various components of the M&E system (Table 1) in

support of progress and performance reviews.

Table 1: The 12 Components of a functional M&E system

Component Performance goal for this component

1. Organizational structures with M&E functions

Establish and maintain a network of organizations responsible for M&E at the national, sub-national and service delivery levels.

2. Human capacity for M&E Ensure adequate skilled human resources at all levels of the M&E system to ensure completion of all tasks defined in the annual costed M&E workplan. This requires sufficient capacity to use the data and produce relevant reports.

3. Partnerships to plan, coordinate and manage the M&E system

Establish and maintain partnerships among in-country and international stakeholders involved in planning and managing the national M&E system.

4. National multisectoral M&E plan

Develop and regularly update the national M&E plan, including identified data needs, national standardised indicators, data collection procedures and tools as well as roles and responsibilities for implementation.

5. Annual costed M&E workplan

Develop an annual costed M&E workplan including specified and costed M&E activities of all relevant stakeholders and identified sources of funding; use this plan for coordination and for assessing the progress of M&E implementation throughout the year.

6. Advocacy, communication and culture for M&E

Ensure knowledge of and commitment to M&E and the M&E system among policymakers, program managers, program staff and other stakeholders.

7. Routine program monitoring

Produce timely and high quality (valid, reliable, comprehensive and timely) routine program monitoring data.

8. Surveys and surveillance Produce timely, valid and reliable data from surveys and surveillance systems.

9. National and sub-national databases

Develop and maintain national and sub-national databases that enable stakeholders to access relevant data for formulating policy and for managing and improving programs.

10. Supportive supervision and data auditing

Monitor data quality periodically and address obstacles to producing high quality (valid, reliable, comprehensive and timely) data.

11. Evaluation and research Identify evaluation and research questions, coordinate studies to meet identified needs and enhance the use to evaluation and research findings.

12. Data dissemination and use

Disseminate and use data from the M&E system to guide the formulation of policy and the planning and improvement of programs.

19 | P a g e

2.1 M&E Coordination Mechanisms The sector-wide M&E system for effective tracking, evaluation and feedback on HSDP implementation

and results will be followed as defined in the NDP II M&E Strategy. This implies that Central

Government, MoH, LGs, HDPs, CSOs and other stakeholders will be involved directly or indirectly in

the M&E activities. Consequently, a participatory approach that entails the involvement of all key

actors and primary stakeholders will be adopted. This will enable all key actors to fully internalize and

own the system as well as use the results to inform their actions.

Better coordination of service delivery is a key element required to maximize the outputs of the health

sector. Coordination of M&E activities in the health sector will be through the existing organizational

structures of the health sector (See Figure 1).

Figure 1: Health Sector M&E National Coordination Structure

Quality Assurance

Department

Department M&E

Focal Persons /

Health Facility Manager

Health Information

Division

Planning Department

Senior Management Committee

HPAC

Top Management

SMER TWG

Regional M&E

Teams

District Health

Team

Regional M&E

Teams

District Health

Team

Figure 2: District Level M&E National Coordination Structure

2.2 Roles and Responsibilities In order to avoid over-laps, role conflicts, and uncertainty in the M&E function during the

implementation of the HSDP, roles and responsibilities of key actors are specified below.

2.2.1 Roles and Responsibilities of Senior Top Management

The Senior Top Management is comprised of the 3 Ministers. They shall work closely with the

Cabinet through the Parliamentary Health Committee for;

i) Overall political, and policy oversight.

ii) Articulating the policy direction for the sector, taking broader Government objectives into

consideration.

iii) Review of sector progress against the policy imperatives set out in contribution towards the NHP

II and NDP II.

This function will be supported by reports of the Auditor General, NPA and other statutory agencies.

District Technical

Planning Committee

District Social Services

Committee

District Health

Management Team

Community / Households / Individuals

District Executive Committee

District Health Team

Health Sub District

Management Team

Health Facility

Manager

Health Facility

Manager

CHEW / VHT CHEW / VHT

Health Sub District

Management Team

Health Facility

Manager

Health Facility

Manager

CHEW / VHT CHEW / VHT

21 | P a g e

2.2.2 Roles and Responsibilities of Top Management

The Top Management is comprised of the Permanent Secretary, Director General of Health Services,

Directors and Commissioners.

The M&E roles and responsibilities for the top management are;

i) Providing governance and partnership oversight to the sector.

ii) Reviewing of sector progress against the policy imperatives set out in the NHP II and NDP II.

iii) Monitoring adherence to the policy direction (One M&E platform) of the sector.

iv) Mobilizing resources for operationalizing the plan.

v) Monitoring health sector performance and six-monthly reporting to OPM on sector performance.

This performance reporting will be based on the quarterly submissions to OPM on progress against

key actions, and outputs towards outcomes.

2.2.3 Roles and Responsibilities of Health Policy Advisory Committee (HPAC)

HPAC is a forum for the Government, HDPs, private sector, PNFPs, CSOs, academia and related line

ministries.

The role of HPAC in implementation of this plan is to;

i) Monitor and advise on health policy issues.

ii) Monitoring adherence to the policy direction (One M&E platform) of the sector.

iii) Monitor implementation of the partnership arrangements e.g. the Compact and aide memoire

recommendations.

iv) Provide guidance for the sector performance reviews.

2.2.4 Roles and Responsibilities of SME&R TWG

The SME&R TWG is comprised of MoH representatives from the different programs, CSOs, HDPs,

Medical Bureaus, Private Sector and academia and reports to the Senior Management Committee.

The TWG will be responsible for;

i) Developing and reviewing the results framework for the HSDP, and for ensuring that relevant

departments (and relevant non-state actors) develop results indicators that are consistent with

the HSDP.

ii) Reviewing, consolidating and validating the various sector reports before dissemination to the

relevant stakeholders.

iii) Facilitating utilization of M&E and Research Information (knowledge translation and

dissemination) in liaison with the relevant sector departments, programs and the Policy Analysis

Unit.

iv) Periodically reviewing available research/survey information to update the current evidence on

best practices in order to guide Planning, decision-making or Policy Formulation.

2.2.5 Roles and Responsibilities of Quality Assurance Department (QAD)

The QAD is responsible for overall coordination of the implementation of the HSDP M&E Plan.

However, MoH has proposed to the MoPS the establishment of a fully fledged M&E Unit to strengthen

the M&E function. The MoH M&E sub-units will work under the guidance of the QAD in

implementation of this plan.

QAD is responsible for;

i) Overall coordination and oversight (monitoring and supervision) of M&E activities in the sector.

ii) Development and dissemination of the sector M&E plan for the HSDP.

iii) Ensuring the harmonization of the institutional, program and project M&E plans with the HSDP

M&E Plan

iv) Identifying capacity building needs and training for health workers and managers in M&E.

v) Organizing sector performance reviews.

vi) Supporting LGs to organize regular performance review meetings.

vii) Producing the quarterly sector progress reports.

viii) Providing on a quarterly basis, data and explanatory information on progress against performance

indicators to MoFPED and OPM through the Output-based Budgeting Tool (OBT).

ix) Maintaining a Recommendations Implementation Tracking Plan which will keep track of review

and evaluation recommendations, agreed follow-up actions, and status of these actions.

x) M&E of the implementation of the HSDP M&E Plan.

2.2.6 Roles and Responsibilities of Health Information Division

The HID will have the primary responsibility of;

i) Coordinating, harmonizing and operationalizing the HMIS and e-HMIS at all levels.

ii) Strengthening capacity for collection, validation, analysis, dissemination and utilization of health

data at all levels.

iii) Conducting regular data validation in the districts, health facilities and other health institutions to

ensure quality data.

iv) Ensure that HMIS and e-HMIS data is made easily available to all stakeholders in a timely manner,

while ensuring that the sharing of reports respects the Access to Information Act, 2005.

v) Conduct data review meetings include data use conferences to enhance data utilization at all

levels.

vi) Updating the master health facility inventory of all reporting health facilities in the country.

vii) Ensure the ICD 10 coding of all diagnoses as outlines in the HMIS, and consequently updating these

in the eHMIS.

viii) Generating the health statistical report annually.

2.2.7 Roles and Responsibilities of the Departmental Heads and M&E Focal Persons /

Specialists

Central level departments and institutions will be centers for performance monitoring as well as

reporting on progress of their plans against the set targets and actions. They will also be the direct

consumers of the outputs and outcomes of this M&E Plan.

The roles and responsibilities of the departmental heads or M&E focal persons include;

i) Provide oversight for monitoring implementation of work plans and preparation of quarterly and

annual performance reports.

ii) Participating in data quality assurance.

iii) Providing quality data on relevant performance indicators to MoH and relevant stakeholders.

iv) Participate in M&E capacity building activities.

v) M&E support supervision and mentoring.

23 | P a g e

vi) Participating in development of the program M&E plans, Mid- and end-term evaluation of national

strategic plan and preparation of the periodic sector performance reports.

vii) Maintaining a Recommendations Implementation Tracking Plan which will keep track of review

and evaluation recommendations, agreed follow-up actions, and status of these actions.

viii) Utilizing M&E findings to inform program, policy, and resource allocation decisions.

2.2.8 Roles and Responsibilities of Regional Monitoring Teams

M&E functions at the regional level will be coordinated through designated regional teams.

The regional teams will be responsible for;

i) Liaising between national level and the districts on M&E at regional level.

ii) Capacity building for data collection, validation, analysis, dissemination and utilization of health

data at regional level.

iii) Conducting data validation in the region.

iv) Supporting the development and implementation of the M&E plans of the districts and RRH in the

region.

v) Monitoring and reviewing the implementation of the M&E plans in the region by compiling and

analyzing quarterly and annual reports.

vi) Maintaining a Recommendations Implementation Tracking Plan which will keep track of review

and evaluation recommendations, agreed follow-up actions, and progress of these actions.

vii) Supporting operational research and survey activities.

2.2.9 Roles and Responsibilities of the District Executive Committee (DEC)

At district level the DEC will be responsible for;

i) Providing governance and leadership oversight in the district.

ii) Monitoring implementation of the annual workplan and District Development Plan.

iii) Monitoring adherence of all stakeholders to the policy direction (One M&E platform).

2.2.10 Roles and Responsibilities of the District Social Services Committee (DSSC)

The DSSC is a committee of the District Council and will be responsible for;

i) Monitoring implementation of the annual workplan and District Development Plan.

ii) Mobilizing resources for operationalizing the district M&E plan.

iii) Participating in the district performance review meetings.

2.2.11 Roles and Responsibilities of the DTPC

The DTPC is chaired by the CAO is comprised of all Heads of Departments in the district. The DPTC

will be responsible for;

i) Monitoring implementation of the annual workplan and District Development Plan.

ii) Mobilizing resources for operationalizing the district M&E plan.

iii) Ensure timely reporting to the respective entities (MoFPED, MoLG and MoH).

iv) Coordinating all IPs and CSOs to ensure alignment with institutional arrangements and district

priorities.

2.2.12 Roles and Responsibilities of the DHMT

The DHMT is comprised of the DHT and representatives of the key stakeholders in the district including

the CAO, Secretary for Health, CSOs and IPs in the district. The DHMT will be responsible for;

i) Monitoring implementation of the annual workplan and District Development Plan (Performance

Reviews).

ii) Participating in the district performance review meetings.

2.2.13 Roles and Responsibilities of the DHT

At district level the District Health Team will be responsible for;

i) Development of a district M&E plan.

ii) Identifying key performance indicators and targets.

iii) Coordination of M&E activities in the district to ensure alignment with institutional arrangements

and district priorities.

iv) Supervision and mentoring of HSDs in M&E.

v) Conducting data quality audits.

vi) Training of health workers in M&E.

vii) Maintaining a functional district HMIS with up to date district database.

viii) Compile and submit periodic district reports to the district, MoFPED and MoH

ix) Conducting district performance Reviews.

x) Maintaining a Recommendations Implementation Tracking Plan which will keep track of review


xi) Utilization of M&E results.

2.2.14 Roles and Responsibilities of the HSD Team

At HSD level the HSD Team will be responsible for;

i) Supervision and mentoring of lower level health facilities in M&E.

ii) Aggregation, validation, analysis, dissemination and utilization of district data.

iii) Maintaining an up to date HSD database.

iv) Compile and submit periodic HSD reports to the district.

v) Conducting HSD performance Reviews.

vi) Maintaining a Recommendations Implementation Tracking Plan which will keep track of review


vii) Utilization of M&E results.

2.2.15 Roles and Responsibilities of Health Facility Managers

All facility managers in the public and private health facilities will be responsible for;

i) Ensuring development of facility M&E plans.

ii) Determining performance targets for the key output indicators.

iii) Resource mobilization and allocation for M&E activities.

iv) Maintaining an up to date health facility database.

v) Compile and submit periodic reports to the relevant bodies.

vi) Conduct data verification before submission of reports.

vii) Conducting health facility performance reviews.

viii) Dissemination and utilization of data.

ix) Maintaining a Recommendations Implementation Tracking Plan which will keep track of review


2.2.16 Roles and Responsibilities of the Village Health Team (VHT)

The roles of the VHTs include;

25 | P a g e

i) Collection, compilation, analysis and reporting on community health data including births and

deaths through the community registers.

ii) Use data to discuss performance within the community, and agree on priorities to focus on.

2.2.17 Roles and Responsibilities of Community Level Actors

These comprise of community based CSOs, administrative units at grassroots and health consumers. Their role is; i) To provide information on; i) delivery of various services, ii) transparency and accountability of

resources accorded; and iii) challenges and gaps experienced in delivery of various services.

ii) They will also participate in validation of the outcomes of implementation of the HSDP in their respective areas.

iii) Communities will also be engaged in the review process using participatory appraisal mechanisms like focus group discussions and community meetings or dialogues like the Constituency (HSD) Health Assemblies, barazas, open days, etc.

2.2.18 Roles and responsibilities of other executing agencies and partners

The MoH will work in close collaboration with other agencies and partners in the implementation of this plan. These include UBOS, NIRA, Development Partners and CSOs.

2.2.18.1 Roles and Responsibilities of Uganda Bureau of Statistics (UBOS)

Will be responsible for;

i) Coordinating, supporting, validating and designating as official any statistics produced by UBOS,

MDAs and LGs.

ii) Coordinating and clearing all censuses and nationally representative household economic surveys.

iii) Ensuring production, harmonization and dissemination of statistical information.

iv) Strengthening statistical capacity of planning units in MoH and LGs for data production and use.

v) Ensuring best practice and adherence to standards, classifications, and procedures for statistical

collection, analysis and dissemination in MoH and LGs.

vi) Ensuring that complete and approved health statistical data are made easily available to the public

in a timely manner, while ensuring that the sharing of reports respects the Access to Information

Act, 2005.

Research activities by academic institutions that are related to the M&E discipline will also contribute

in this regard.

2.2.18.2 Roles and Responsibilities of NIRA

NIRA is responsible for;

i) Operating and managing the Civil Events Registry.

ii) Timely processing and dissemination of Vital Statistics.

iii) Capacity building of health providers and community in registration of births and deaths.

iv) Provision of registration equipment and materials.

2.2.19 Roles and responsibilities of CSOs

The CSO coalitions e.g. Uganda Coalition for Access to Essential Medicines (UCAEM), Maternal Health

CSOs, Civil Society Budget advocacy group, Voices for health right, among others will play a coordination

role in monitoring all CSOs to ensure alignment with national priorities.

The role of the CSOs and IPs in the implementation of the M&E Plan will be;

i) Contribution in the development of M&E standards and plans.

ii) Participating in sector monitoring processes at LG and national level.

iii) Providing performance reports and quality data to the relevant program managers at national and

district level. These will be compiled as part of departmental reports to be reviewed by relevant

working groups for onward transmission to SMC or DTPC.

iv) Participating in the M&E related committee meetings at all levels.

v) Conduct independent M&E audits and share findings for performance improvement.

vi) Community sensitization and advocacy for accountability mechanisms.

2.2.20 Roles and responsibilities of HDPs and IPs

The HDPs and IPs in the sector will work closely with the national and sub-national levels to ensure

alignment with national priorities and use of one M&E platform.

The role of the HDPs and IPs in the implementation of the M&E Plan will be;

i) Contribution in the development of M&E standards and plans.

ii) Participating in sector monitoring processes at LG and national level.

iii) Participating in the M&E related committee meetings at all levels.

iv) Utilizing M&E findings for policy dialogue, resource mobilization and planning.

v) Providing feedback to domestic and international constituencies on health sector performance and results.

vi) Supporting the health sector through financial, technical and other forms of assistance to strengthen M&E performance.

2.3 Capacity Building Strategy The sector institutions shall ensure availability of adequate skilled human resources in all aspects of

M&E at all levels of the M&E system. M&E personnel require sufficient analytical capacity to use the

data and produce relevant reports. To ensure this, the sector shall develop/improve M&E human

resource capacity through training, providing guidelines and tools, supportive supervision and

mentoring.

2.3.1 Training

Training needs assessments in M&E will be conducted to identify actual needs and tailored program

developed to address capacity gaps. Training approaches to include on-job training, coaching /

mentoring, Continuous Medical Education sessions, workshops or approved M&E courses (distance

and otherwise).

All District Health Teams and M&E staff will be oriented on the M&E Plan and current M&E tools.

Particular attention will be paid to strengthen capacity for data quality assessment, data analysis and

synthesis and use of data for progress and performance reviews within LGs, MoH Departments, semi-

autonomous Institutions, PNFP & PFP facilities and CSOs. Other areas of focus will include training on

the concept of performance based monitoring and management and target setting. The MoH will

leverage the expertise and capacity of in-country institutions such as academic, public health and

27 | P a g e

research institutions to conduct in-service training in analytical skills that will facilitate knowledge

management.

2.3.2 Providing Guidelines and Standard Operating Procedures

One of the ways to enable health workers generate quality data and routinely monitor service delivery

is to ensure that current standards, guidelines and Standard Operating Procedures (SOPs) are

reviewed and disseminated. The M&E Plan is one such document that will be disseminated to all

districts and health facilities. In addition other documents like the HMIS manual, Data Quality Manual,

program M&E plans will be reviewed and disseminated.

2.3.3 Supportive Supervision and mentoring

Supportive supervision is mainly conducted to assess level of performance against standards. This

process involves “directing and supporting staff so that they may effectively perform their duties

through observation, discussion, guidance/support and on-the-job training using mentoring and

coaching methods.

During implementation of this M&E Plan the health sector shall undertake the following;

Review and disseminate M&E support supervision tools.

Conduct regular M&E support supervision and mentorship at all levels.

The supervisors are to;

Work with staff and the community to identify appropriate interventions that will lead to

improved M&E system.

Facilitate teamwork at organisational level and between the sub-national, national level and the

facilities.

Ensure that facilities have relevant M&E standards, guidelines and tools.

Facilitate districts and facilities to develop M&E plans.

Review completeness and accuracy of reports (data quality) as well as timeliness of reporting.

Work with staff to use data to evaluate results (keep track of action plans, other tools).

Work with staff to assess training needs, plan and conduct training.

Mobilize resources from many different sources to implement M&E workplans.

3 Monitoring and Evaluation Framework Chapter three defines the M&E Framework for the HSDP, main M&E events, key indicators and targets

for monitoring performance in the sector, data sources, data management, dissemination, use,

evaluation, surveys and surveillance.

3.1 The M&E Framework The monitoring framework for tracking progress is informed by the need to comprehensively monitor

and review sector progress. The framework for the analysis is based on the common steps of the

M&E logical framework, which shows the way in which inputs may lead to desirable health impact.

The health sector shall apply the IHP+ common M&E Framework which provides a logical and results-

chain representation of the key components of the HSDP M&E (see Figure 3). It comprises four major

indicator categories: system input and processes, outputs, outcomes, and impact.

The framework shows how inputs to the system (e.g. financing, infrastructure) and processes (e.g.

supply chain) are reflected in outputs (such as availability of services and interventions) and eventual

outcomes (e.g. intervention coverage) and impact (e.g. improved health outcomes). Figure 3: IHP+ Common M&E Framework

Source: Monitoring, Evaluation and Review of National health Strategies, WHO 2011

Inputs and processes Outputs Outcomes Impact

Go

vern

ance

Fin

anci

ng

Infrastructure, Information and communication

technologies

Health workforce

Supply chain

Information

Coverage of interventions

Prevalence risk behaviours and

factors

Improved health

outcomes and equity

Social and

financial risk protection

Responsiveness

Efficiency

Intervention access and

services readiness

Intervention

quality, safety

Administrative sources Financial tracking system; National Health Accounts; Databases and records, HR, infrastructure, medicines, etc Policy data

Facility assessments Service readiness, quality, coverage, health status

Population based surveys, coverage, health status, equity, risk protection, responsiveness

Clinical reporting systems

Civil registration

Indicator domains

Analysis

Communication

and Use

Data quality assessment; Review of progress and performance; Evaluation

Country review process; Global reporting

Data

Collection

29 | P a g e

3.2 M&E Events The main M&E events, purpose / description, main actors and timeframe are summarized in Table 2.

Table 2: The M&E events and processes

Main M&E Events Purpose and Description Main actors Frequency

Baseline Surveys Establish basis for measuring progress of the HSDP Implementation overtime

UBOS, NIRA, MOH, Academia

Every 5 years, annually

Surveys/studies Basis for a 'before and after' assessment of the HSDP progress

UBOS, NIRA, MOH, Academia, Partners

Ongoing

Establishing Management Information Systems

Management of M&E data UBOS, MOH, LGs, Facilities, Partners

Ongoing

Evaluations To provide feedback on effectiveness, efficiency, and adequacy, of the HSDP implementation and to identify probable areas for improvement.

MoH, HDPs, Private Sector, CSOs, Researchers, Academia and partner organizations

Mid term and end term

Performance Reviews

To review progress in implementation of the Ministerial Policy Statement and workplans against the targets sets.

MOH, HDPs, Private Sector, CSOs, Researchers and Partner Organizations

Quarterly, Semi-Annually and Annually

Technical Reviews To review thematic areas and discuss key successes and challenges, identify areas for modification of operations / implementation and make adjustments.

MOH, HDPs, Private Sector, CSOs, Researchers, Academia and Partner Organizations

Once a year - March - April.

M&E capacity building

Increase knowledge regarding the development monitoring and evaluation systems among key stakeholders involved in the HSDP implementation

MOH, LGs & Partner Organizations

Continuous

Information sharing

Enhancing smooth implementation of the HSDP

MOH, HDPs, Private Sector, CSOs, Researchers, Academia and Partner Organizations

Continuous

3.3 Indicators The ability to monitor and evaluate in the health sector is essential if we are to correctly target

interventions and assess whether they are having the desired impact. Different indicators are available

to guide performance in health. The sector shall use both program based, and sector level monitoring,

and use of indicators for each.

Program based monitoring is able to inform on progress being made at the program level, at a level

of detail sufficient to target implementation of available interventions. As such, many indicators are

usually employed, each providing specific information, on its own, about a different aspect of the

program. On the other hand, sector monitoring is higher level monitoring of whether the multitude of

activities being carried out are having the desired impact on the sector goals. A single indicator on its

own is insufficient to inform on sector progress – rather a number of different indicators are

employed. These shall be called key indicators.

3.3.1 Key Indicators

Key indicators are defined, and structured to inform on, and compare trends across the different

indicator domains. The key indicators guide analysis of sector progress, at all the indicator domains –

input / process, output, outcome, and impact.

Selection of the key indicators was through a participatory process, bringing together key decision-

makers across priority diseases addressed in the HSDP and health system components. The 41 key

indicators are based on the following critical variables:

They reflect all domains in the M&E conceptual framework,

Are aligned to existing sector and global monitoring commitments.

Considerations of scientific soundness, relevance, usefulness for decision-making,

responsiveness to change, and data availability.

Responsiveness to the information needs for monitoring progress and performance towards

the main objectives of the HSDP.

Table 3 presents all the key indicators showing the domain, data collection method, frequency of data

collection, agency responsible for data collection and reporting, baseline values with dates and source

of data and targets according to frequency of measurement.

The annual targets were set based on computations that include the likely availability of funding, on

how this can be translated into intervention access and coverage, and ultimately on health impact in

addition to taking the international targets of the post 2015 MDG agenda into consideration. The

assumption was that all factors contributing to the attainment of the targets will be addressed. There

will be a review of the indicator targets during the midterm review of the HSDP and adjustment made

where necessary based on the level of achievement and other factors like funding and responsiveness

to the information needs.

The indicator matrix in Table 4 shows the HSDP objectives, key result areas, indicators, data collection

methods, frequency of data collection, agency responsible, baseline and annualized indicator targets.

31 | P a g e

Table 3: HSDP 2014/15 – 2015/16 Key Indicators by Domain

INPUT & PROCESS (7) OUTPUT (13) OUTCOME (17) IMPACT (5)

Health financing Service access and availability Coverage of interventions Health status

1 General

Government budget

allocated on health

as % of total

government budget

8 New OPD utilization rate 21 ANC 4 Coverage 36 Maternal Mortality

Ratio

2 Out of pocket health

expenditure as a %

of Total Health

Expenditure

9 Hospital (inpatient)

admissions per 100

population

22 DPT3HibHeb3 coverage 37 Neonatal mortality

rate

Workforce 10 Bed occupancy rate

(Hospitals & HC IVs)

23 Measles coverage under

1 year

38 Infant Mortality

Rate

3 Annual reduction in

absenteeism rate

11 HC IVs offering CEmOC

Services

24 Malaria cases per 1,000

persons per year

39 Under 5 mortality

rate

4 Approved posts in

public facilities filled

with qualified

personnel

12 Availability of a basket of

commodities in the previous

quarter (% of facilities that

had over 95%)

25 Under-five Vitamin A

second dose coverage

40 Total Fertility Rate

5 Number of health

workers (doctors,

midwives, nurses)

per 1,000

population

Service quality and safety 26 Intermittent Presumptive

Treatment 3 or more

doses coverage for

pregnant women

41 Adolescent

Pregnancy Rate

Infrastructure 13 Client satisfaction index 27 TB Case Detection Rate

6 Population living

within 5km of a

health facility

14 Average length of stay

(Hospitals & HC IVs)

28 ART Coverage

Health Information 15 Facility based fresh still

births (per 1,000 deliveries)

29 HIV+ pregnant women not

receiving HAART

receiving ARVs for

eMTCT during pregnancy,

labour, delivery &

postpartum

7 Timeliness of

reporting (HMIS

105)

16 Maternal deaths among

100,000 health facility

deliveries

30 Contraceptive Prevalence

Rate

17 Maternal death reviews

conducted

31 Couple years of

protection

18 Under five deaths among

1,000 under 5 admissions

Risk factors and behaviours

(4)

19 ART Retention rate 32 Latrine coverage

20 TB Treatment Success

Rate

33 Villages/ wards with a

functional VHT

34 Children below 5 years

who are stunted

35 Children below 5 years

who are under weight

Table 4: HSDP 2015/16 – 2019/20 Indicator Matrix

Objective Key Result Area Indicator Data

collection

method

Frequency

of data

collection

Agency

Responsible

Baseline Annual Targets

2015/16 2016/17 2017/18 2018/19 2019/20

To accelerate

movement

towards UHC

with essential

health and

related services

needed for

promotion of a

healthy and

productive life.

HEALTH IMPACT

Health impact

trends

Maternal Mortality Ratio (per 100,000)

Survey Every 5

years

UBOS 438 (2011)

425 320

Neonatal Mortality Rate (per 1,000)

Survey Every 5

years

UBOS 26 (2011)

26 16

Infant Mortality rate (per 1,000)

Survey Every 5 years

UBOS 54 (2011)

50 44

Under five mortality rate (per 1,000)

Survey Every 5

years

UBOS 90 (2011)

64 51

Total Fertility Rate Survey Every 5

years

UBOS 6.2 (2011)

5.9 5.1

Adolescent Pregnancy Rate

Survey Every 5

years

UBOS 24% (2011)

23% 14%

To contribute to

the production

of a healthy

human capital

for wealth

creation through

provision of

equitable, safe

and sustainable

health services.

HEALTH & RELATED SERVICES OUTCOME

TARGETS

Communicable

disease prevention

& control

ART Coverage HMIS Annually MoH 42% (2013/14)

57% 65% 72% 80% 80%

HIV+ pregnant women not

on HAART receiving

ARVs for eMTCT during

pregnancy, labour,

delivery and postpartum

HMIS Annually MoH 72% (2013/14)

85% 87% 90% 95% 95%

TB Case Detection Rate (all forms)


73% 75% 78% 81% 84%

IPT3 or more doses coverage for pregnant women


64% 71% 79% 86% 93%

In patient malaria deaths per 100,000 persons per year

HMIS Annually MoH 30 (2013/14)

13 5 5 5 5

33 | P a g e


collection

method

Frequency

of data

collection

Agency

Responsible


2015/16 2016/17 2017/18 2018/19 2019/20

Malaria cases per 1,000 persons per year

HMIS Annually MoH 460

(2013/14)

373 329 285 242 198

Under-five Vitamin A second dose coverage

HMIS Annually MoH 26.6% (2013/14)

58% 60% 62% 64% 66%

DPT3HibHeb3 coverage HMIS Annually MoH 93% (2013/14)

95% 95% 95% 97% 97%

Measles coverage under 1 year


90% 92% 95% 95% 95%

Essential clinical

and rehabilitative

care

Bed occupancy rate (Hospitals & HC IVs)


62% 70% 80% 85% 90%

MoH 50% (2013/14)

55% 60% 65% 70% 75%

Average length of stay (Hospitals & HC IVs)

HMIS Annually MoH Hospital 4 (2013/14)

4 3 3 3 3

MoH HC IV 3 (2013/14)

3 3 3 3 3

Contraceptive Prevalence Rate


MoH 30% (2011)

39% 50%

Couple years of protection HMIS Annually MoH 4,074,673 (2013/14)

4.3 M 4.4 M 4.5 M 4.6 M 4.7 M

ANC 4 coverage HMIS Annually MoH 32.4% (2013/14)

37.5% 40% 42.5% 45% 47.5%

Health Facility deliveries HMIS Annually MoH 44.4% (2013/14)

54% 56% 58% 60% 64%

HC IVs offering CEmOC Services


55% 55% 57% 59% 60%

HEALTH INVESTMENT OUTPUT TARGETS

Health

Infrastructure

New OPD utilization rate HMIS Annually MoH 1.0

(2013/14)

1.1 1.2 1.3 1.4 1.5

Hospital (inpatient) admissions per 100 population

HMIS Annually MoH 6

(2013/14)

7 8 9 10 10


collection

method

Frequency

of data

collection

Agency

Responsible


2015/16 2016/17 2017/18 2018/19 2019/20

Population living within

5km of a health facility

Household

Survey

Annually MoH 75% 77% 80% 82% 84% 85%

Medicines and

health supplies

Availability of a basket of

commodities in the

previous quarter (% of

facilities that had over

95%)

HMIS Annually MoH To be

determined

86% 100% 100% 100% 100%

Improving quality of

care

Facility based fresh still births (per 1,000 deliveries)

HMIS Annually MoH 16 (2013/14)

15 14 13 12 11

Maternal deaths among 100,000 health facility deliveries


(2013/14)

114 110 106 102 98

Maternal death reviews HMIS Annually MoH 33.3% (2012/13)

38% 45% 52% 59% 65%

Under five deaths among 1,000 under 5 admissions


(2013/14)

17.6 17.3 16.9 16.5 16.1

ART Retention rate HMIS Annually MoH 79.7%

(2013/14)

83% 84% 84% 84% 84%

TB Treatment Success

Rate

Program Reports

Annually MoH 80%

(2013

Cohort)

82% 84% 86% 88% 90%

Responsiveness Client satisfaction index Surveys Annually MoH 69%

(2014)

71% 73% 75% 77% 79%

Health Information Timeliness of reporting

(HMIS 105)


88% 90% 93% 95% 97%

To increase

financial risk

protection of

households

Health Financing Out of pocket health expenditure as a % of Total Health Expenditure

NHA Annually MoH 37% (2011/12)

37% 35% 33% 31% 30%

General Government allocation for health as %

MTEF Annually MoH 8.7% (2013/14)

10% 12% 14% 15% 15%

35 | P a g e


collection

method

Frequency

of data

collection

Agency

Responsible


2015/16 2016/17 2017/18 2018/19 2019/20

against

impoverishment

due to health

expenditures.

of total government budget

Human Resources Approved posts in public

facilities filled with

qualified personnel

HR

Biannual

Report

Annually MoH 69%

(April

2015)

69% 70% 72% 76% 80%

Number of health workers

(doctors, midwives,

nurses) per 1,000

population

HRIS

Annually MoH Doctors

1:24,725

1:24,725 1:24,500 1:24,300 1:24:000 1:23,500

Midwives

1:11,000

1:11,500 1:11,000 1:10,500 1:10,000 1:9,500

Nurses

1:18,000

(HSSIP

MTR 2013)

1:18,500 1:18,300 1:18,000 1:17,500 1:17,000

To address the

key

determinants of

health through

strengthening

intersectoral

collaboration

and

partnerships.

Social and

economic

determinants of

health

Children below 5 years who are stunted


UBOS 33% (2011)

31% 29%

Children below 5 years who are under weight


UBOS 14% (2011)

14% 10%

Health promotion &

environmental

health

Latrine coverage Program Annually MoH 73% (2013/14)

74.6% 76% 78% 80% 82%

Villages/ wards with a functional VHT

Program Annually MoH 72% (2013/14)

75% 80% 85% 85% 85%

3.3.2 Program and Project specific indicators

Specific programs and projects have their own strategic and operational plans that are more detailed

than the HSDP. They are also expected to develop specific program / project M&E Plans which will

include more indicators to measure process, outputs and immediate outcomes. These should

however, be aligned with the goal, objectives and strategic interventions of the HSDP to demonstrate

the effects of health system strengthening to health outcomes.

3.4 Data Sources The data needs of the HSDP are based on agreed performance indicators (core and program specific)

to facilitate M&E, reporting and decision-making. The main data sources will include;

Community generated data will be collected by the approved community based health structures

like the VHTs and Community Health Extension Workers (CHEWs) through the Community Health

Management Information System (CHMIS) linked to the e-HMIS.

Facility generated data will be collected by all public and private health service delivery facilities.

In addition different programs and projects managed at the MoH/national level shall provide

reports to the RC and other stakeholders on program-specific activities. Health projects managed

by implementing partners (DPs and CSOs) at district or community level shall provide reports

through the district health system. This data will be collected routinely using the established HMIS.

Administrative data sources will provide information on health inventories, supervision,

management meetings, logistics management, human resource, financial resource flows and

expenditures at national and sub-national levels.

Population based health surveys mainly carried out by Uganda Bureau of Statistics (UBOS) and

other institutions that generate data relative to populations (population studies) as a whole.

Research Institutions and academia that carry out health systems research, clinical trials and

longitudinal community studies will also provide data for interpretation and possible use by the

sector.

Civil registration and vital statistics system is operated and managed by the NIRA. It is responsible

for registering all vital events including births and deaths.

Population and Household Census is carried out every ten years and will be the primary source

of data on size of the population, its geographic distribution, and the social, demographic and

economic characteristics. Annual projections at national and sub-national level will be provided

by UBOS.

Other surveys carried out depending on the data needs e.g. facility assessments, financial studies.

Overall, the sources of M&E information will be guided by different information needs, particularly

the Government, Parliament, DPs, private sector and the community.

3.4.1 Critical data gaps and weaknesses and how to address these

As noted above in section 1.3 on the situation analysis of the M&E practices and mechanisms, the

sector has registered improvements in most of the M&E system components however, there are still

a number of data gaps and weaknesses in data management as indicated below;

1) Low reporting rates from the private sector.

2) Data quality gaps

3) Delayed and incomplete financial data reporting.

37 | P a g e

4) Underutilization of the existing IT to generate data on health infrastructure, equipment and

commodities, service delivery, and health workforce.

5) Inadequate / irregular funding for surveys.

6) Analysis, synthesis, effective dissemination and use of information to guide policy dialogue and

implementation of health programs remain a challenge.

7) Inadequate HMIS equipment (computers, modems) at hospital and lower levels.

8) Inadequate reporting on the vital statistics (births and deaths)

Recommendations for improving data gaps are;

1) Appropriate and strategic advocacy should be carried out for the private sector to report through

the national system.

2) Increased supervision, monitoring and feedback to districts to address data quality gaps.

3) Improving administrative data sources including systems of tracking financial resource flows and

expenditures to sub-national levels.

4) IT skills development for health workers.

5) Advocacy for appropriate funding (level, mechanisms) for surveys.

6) Use of data should be enhanced through meaningful analysis, appropriate presentation and

effective dissemination.

7) Skills development for data disaggregation. Rational distribution of IT equipment for data

management.

8) Provision and maintenance of HMIS equipment.

9) Scale up birth and death reporting to all districts and health facilities and community through the

Mobile Vital Registration System.

3.5 Data management

3.5.1 Responsibilities for data management

There are various players involved in data management. Data management involves

data collection,

data validation,

feedback,

analysis / synthesis,

dissemination and use.

Table 5 below shows the key data management activities and the responsible persons.

3.5.2 Data collection

The methods of data collection will be a combination of quantitative and qualitative methods using

standardized data collection tools and techniques. Most data in respect of some indicators will be

collected annually, and any survey-based indicators will be collected as predetermined. Efforts will be

made to ensure that data is provided timely as indicated in the indicator matrix.

Table 5: Responsibilities for data management

Activity Responsibility

1. Compile and process administrative data into

departmental / Institutional records (minutes,

inventory) and reports (supervision, activity)

Managers at all level

2. Conduct surveys and evaluations and compile

reports

UBOS, Research Institutions, Program

Managers

3. Compile and submit routine facility HMIS

reports

Medical Records Officers / Health

Information Assistants

4. Receive and enter health statistical data into

the DHIS-2

Biostasticians / Information Officers at

District, HSD and Hospitals

5. Data validation MoH RC, Program Managers, DHTs,

Health Facility Managers

6. Provide feedback on reports submitted MoH RC, DHOs, HSD In-charges, Health

Facility Managers

7. Data analysis and synthesis MoH RC, M&E Officers, DHTs, HSD Team,

Health Facility Managers, Health

Information Officers / Assistants, UBOS,

NIRA

8. Data dissemination DGHS, Program Managers, DHO, HSD I/C,

Health Facility Managers, UBOS, NIRA

3.5.3 Data analysis and synthesis

The framework for reviewing health progress and performance covers the M&E process from routine

performance monitoring, quarterly reviews, annual review and evaluation of all the HSDP indicator

domains (Figure 3 above). Specific questions will have to be answered during the different review

processes, especially the annual reviews, but also the performance monitoring.

Health progress and performance assessment will bring together the different dimensions of

quantitative and qualitative analyses and will include analyses on:

(i) Progress towards the HSDP goals;

(ii) Equity

(iii) Efficiency

(iv) Qualitative analyses of contextual changes; and

(v) Benchmarking.

Data analysis and synthesis will be done at all levels (national, sub-national to community) to enhance

evidence-based decision-making. All relevant data will be synthesized based on determined

parameters (disaggregated) where applicable and analyzed for use at various levels of the sector. The

results obtained will be summarized into a consistent assessment of the health situation and trends,

using key sector performance indicators and targets.

Basic indicator information shall be the national average achievement. This is obtained from collating

all the available information from all reporting units into the national figure. Sub analyses of the

indicator information shall be carried out, to provide information on the impact of multi-dimensional

39 | P a g e

poverty on actual coverage, and health status and financial risk protection achievements. This shall

enable better targeting of strategies to address the multi dimensional poverty issues impacting on the

results being sought.

The required levels of disaggregation may not be possible on an annual basis. As a proxy, therefore,

the sector will use district rankings for the different poverty and equity dimensions to separate

districts with high and low attainment of the respective index. The indicator achievements for the top

quintile of districts will be compared with the achievements of the bottom quintile of districts to

illustrate any differences. The focus of analysis will be on comparing planned results with actual ones,

understanding the reasons for divergences and comparing the performance at different levels.

Information on indicators will therefore be analysed in the following lines;

Overall national achievement

Disaggregation of achievement, by

o Age

o Sex

o Region, and district (new and old)

o Poverty index

o Literacy level

Progress towards HSDP goals: The monitoring and review process will measure the extent to which

the objectives and goals of the HSDP (core indicators and their targets) have been attained. This will

be complemented by a stepwise analysis to assess which policies and programs were successful; from

inputs such as finances and policies to service access and quality, utilization, coverage of interventions,

and health outcomes, financial risk protection and responsiveness.

Qualitative assessment and analysis of contextual change: This takes into account non-health system

changes, such as socio-economic development that affect both implementation and the outcomes

and impact observed. Qualitative information on the leadership, policy environment and context is

crucial to understand how well and by whom government policies are translated into practice. A

systematic and participatory approach will be used to gather, analyze and communicate qualitative

information. This will be combined with quantitative data as basis for a policy dialogue. This will then

become a solid basis to inform planning cycles, regular reviews and M&E. Such analysis shall include:

- Health sector reforms and policies stating the importance of assuring service coverage for all

communities;

- A critical assessment of the health sector or disease program response and adhering to policy

direction to date;

- How cultural and political factors impact on health or multi-sectoral programs and outcomes;

- Assessment of organizational context, leadership and accountability mechanisms;

- Assessment of the regulatory environment and how it enables or hinders improvements in health

systems and program delivery.

Figure 4: Framework for reviewing health progress and performance

Quality of care assessment will be undertaken for all health facilities annually using the Health Facility

Quality of Care Assessment tool. Each facility will have a scorecard to enable district level assessment

of facilities. At national level, the district average score will be used to determine the quality of services

provided.

Benchmarking: Benchmarking refers to comparisons between and within entities to assess

performance. There are different types of benchmarking which may vary according to level of

comparison (national or sub-national comparisons), level of assessment (individual service provider –

facility – care organization – district – region – national), measurement focus (process, outcomes,

quality, performance), and use of data (public reporting, accountability, internal reporting only, self-

learning and improvement).

The following tools will be used for benchmarking:

Program specific scorecards

District League Table to be compiled and disseminated quarterly and annually.

HC IV Performance Assessment compiled annually as part of the AHSPR.

General Hospital Performance Assessment compiled annually.

Regional referral and large PNFP hospital performance assessment (SUO) compiled annually.

Health facility quality of care assessment scorecard.

3.5.4 Reporting

Regular reporting using the HMIS and other sources of data will be used to generate relevant

information at all levels. The analytical outputs that will be produced as the basis for decision-making,

program management, financial disbursements and global reporting are;

41 | P a g e

1) Annual Health Sector Performance Report

2) Annual Health Statistical Abstract

3) Annual Program / Project reports

4) Annual Report to National Planning Authority

5) Quarterly Progress Reports

6) Quarterly fiscal performance reports (OBT reports)

1. The Annual Health Sector Performance Report (AHSPR)

The AHSPR is a mandatory report by the constitution for all MDAs. The AHSPR brings together all data

from different sources, including the facility reporting system, household surveys, administrative data

(minutes, supervision reports, financial reports, SCM reports, HRIS reports, etc) and research studies,

to answer the key questions on progress and performance using the HSDP key output indicators and

health goals. The AHSPR will present a detailed account of annual performance against the key output

and programmatic indicators of the sector strategic plan, comparing current results with results of

previous years, and formulate challenges and recommendations by cluster and program. The AHSPR

should be produced by August of the following Financial Year, and will be a key input to the joint sector

review that should also take place in August/September. Annual sub-national performance reports

shall be presented and discussed at the relevant annual stakeholders’ fora.

2. Annual Health Statistical Abstract

The Annual Health Statistical abstract is compiled from the statistical reports submitted through the

HMIS. This feeds into the UBOS statistical abstract for MDAs ahead of the government planning cycle.

3. Annual Program / Project Reports

Annual program / project reports are a requirement from all programs and projects based on their

specific M&E plans. Progress review reports shall be submitted to the MoH M&E unit before the

annual sector reviews.

4. Annual Sector Report to National Planning Authority

The annual sector report to NPA is required to report progress on implementation of the NDP

intervention matrix by August of the following Financial Year. This feeds into the National

Development Report which is presented to the National Planning Forum chaired by H.E. the President.

5. Quarterly Progress Reports

Regular performance monitoring is key in keeping track of progress in implementation of workplans. All service delivery levels will compile quarterly progress reports to be discussed at the quarterly review meetings. At National Level (MoH), quarterly progress reports will be presented and discussed during the sector quarterly review meetings. Quarterly district performance (Quarterly District League Table) will also be disseminated and discussed at this forum. At sub-national level (Regional and district), quarterly performance reports will be presented and discussed at the quarterly review meetings attended by the key implementers.

6. Quarterly Fiscal Performance Reports

MDAs are required to report quarterly to the MoFPED and OPM on a limited number of indicators that

reflect performance in terms of service delivery outcomes (health service coverage), contributory

outputs and main actions. The quarterly fiscal performance reports are generated from the OBT and

aim at linking inputs to activities, outputs and outcomes. The OBT is also used for financial

implementation monitoring addressing whether or not budgets have been released and spent in line

with the planned activities in the Ministerial Policy Statements and BFPs. Reports are submitted to

MoFPED and OPM and are the basis for subsequent financial releases and quarterly reviews for LGs.

The M&E reports will be validated by key stakeholders to:-

i) Obtain stakeholder insight on the information generated;

ii) Mitigate bias through discussion of the information generated with key M&E strategy actors

and beneficiaries;

iii) Generate consensus on the data findings and gaps; and

iv) Strengthen ownership and commitment to M&E activities.

In order to ensure coordinated reporting and routine feedback on performance to sub-national and

private providers, it is crucial that all service delivery and administrative structures adhere to the

following data flow mechanism.

43 | P a g e

Figure 5: Data Flow Diagram

3.5.5 Data Quality

The objective of Data Quality Audits (Assessments) and Adjustment (DQAA) is to ensure that the data

used by the stakeholders to make decisions is sound and accurate.

3.5.5.1 Data Quality Audits (DQA)

DQAs will be conducted in line at all levels of health care service delivery with the MoH DQA guidelines

and using the approved tools.

Specific efforts will be made to undertake DQAs including: application of the computed

validation/data accuracy index into district annual reports; specific support for outliers; routine

(quarterly) data checks on a sample of districts among others. Regular data verification for facility

based data for accuracy and completeness will be carried out at least monthly by the health facility in-

charges.

The various processes in the DQA will take care of: data collection methods, aggregation and analysis

on a quarterly basis. The key DQA activities are;

1) Training of staff in conducting DQAs

Technical Support

Supervision, DQA,

feedback, M&E

Technical Support

Supervision, DQA,

feedback, M&E

Feedback,

M&E

District Database (DHIS, HRIS, SCMS)

Resource Centre (DHIS, HRIS, SCMS)

UBOS

Implementers Public / Private Health Facilities CSOs/Projects

Reporting,

sharing &

dissemination

Reporting, sharing & dissemination

Data collection,

cleaning,

aggregation,

reporting

Data collection,

cleaning,

aggregation,

reporting

National Reporting to OPM and NPA

DQA,

feedback

2) Conducting regular DQAs

3) Data adjustments

4) Compiling and disseminating DQA reports.

This shall be undertaken by;

Health Facility In-charges at facility and community level.

HSD HMIS Focal Person within the HSD.

District Biostatistician within the districts at the various HSDs and health units.

Technical staff of the MoH/HID and Regional Teams at the district level.

Independent DQAAs will be conducted at the mid-term and end evaluation of the HSDP.

3.6 Data dissemination and use Data will be packaged and disseminated in formats that are determined by management at the various

levels. Service delivery data shall be packaged and displayed at the various levels using the HMIS

formats already provided. The timing of information dissemination should fit in the planning cycles

and needs of the users through reports, score cards, bulletins, case studies, among others.

3.6.1 Decision-support tools and approaches

Data should be presented in usable formats to allow policy makers to make well informed decisions

within the limited timeframe. The MoH will use a variety of decision-support tools and approaches

such as data dashboards, health summary bulletins, health status report cards, and colour-coded data

presentation techniques depending on the audience.

Health summary bulletins -These will be used to disseminate data in the AHSPR and program

reports which provide an overall picture of the health status in the country.

Health status report cards - Will be used to report on HSDP core indicators or program areas to

compare current progress to a target or to past report card trends.

Policy briefs - Will be used for conveying specific evidence-based policy recommendations arising from

the M&E system e.g. research findings.

Data dashboards visually present critical data in summary form so that decisions can be made quickly.

Dashboards assist in the management of the large amounts of data that are being collected by health

programs by tracking key program metrics and displaying trends. This allows users to identify

problems and target specific follow-up activities to improve services.

3.6.2 Data Communication

The MoH will use various communication channels including Information Communication Technology

(ICT) in order to ensure public access to data and reports. Quantitative and qualitative data will be

made publicly accessible through the MoH repository under the RC. The public will also be able to

access health information on the MoH website, www.health.go.ug.

45 | P a g e

The Health Education and Promotion Unit in the MoH to translate data and information according to

the target audience and utilize various communication channels e.g. radio, T.V, video conferencing,

teleconferencing, newsletters, booklets, etc.

3.7 Evaluation Evaluation is defined as a systematic and objective assessment of an ongoing or completed program

or policy, its design, implementation and results. The aim is to determine the relevance and fulfilment

of objectives, development efficiency, effectiveness, impact and sustainability. An evaluation should

answer specific evaluation questions and should provide information that is credible and useful,

enabling the incorporation of lessons learned into the decision-making process of both recipients and

donors. Evaluation also refers to the process of determining the worth or significance of an activity,

policy or program.

Evaluations are separately scheduled activities performed at specific intervals (for example baseline,

midterm or at the end of a program / project). The health sector will address different evaluation

questions through:

Evaluations to assess the performance, efficiency and quality of the priority programs;

Thematic evaluations to assess the success and impact of key initiatives.

3.7.1 Evaluations

The health sector will undertake evaluation of the overall HSDP implementation as well as evaluation

of specific programs, projects, policies and interventions. The evaluations will be commissioned by the

MoH and conducted jointly by the MoH M&E Unit, country partners and international agencies. Where

possible, the evaluations will build on previous progress reviews. The type of evaluation to be planned

for and conducted should reflect the nature and scope of the public investment. For example, pilot

projects that are being conducted amongst a random group of participants shall be selected for impact

evaluation to determine whether or not the investment should be scaled up.

As a minimum requirement, investment projects will be required to conduct the following:

(i) A Baseline study during the preparatory design phase of the project

(ii) A Mid-term review at the mid-point in the project to assess progress against objectives and provide recommendations for corrective measures

(iii) A final evaluation or value-for-money audit will be carried out for key front-line service delivery projects where value for money is identified as a primary criterion.

(iv) All other projects will be subjected to standard rigorous final evaluation.

The MoH through the specific program / project managers will be responsible for the design,

management and follow-up of the program and project evaluations (including baseline and mid-term

reviews). All projects are required to budget for periodic project evaluations. All project evaluations

will be conducted by external evaluators to ensure independence. Value for money will be undertaken

by the Office of the Auditor General.

3.7.2 Thematic Reviews

Thematic reviews examine and aggregate information on a specific thematic area of the HSDP. They

look across the portfolio of investments to examine wider systems effects, including health systems

strengthening and institutional development, gender and human rights. The MoH will undertake

annual of thematic reviews in relation to specific strategic interventions focusing on identifying and

discussing key successes and challenges, identify areas for modification of operations /

implementation and make adjustments to facilitate achievement of the planned targets. These will be

conducted at least once annually.

3.8 Surveys and surveillance

3.8.1 Surveys

During the last 5 years a number of major surveys related to the health sector were undertaken.

These include;

i) UDHS 2011

ii) HIV/AIDS Indicator Survey (AIS) - 2011

iii) Uganda Health Systems Assessment - 2011

iv) National Health Accounts (NHA) 2010/11 and 2012

v) Service Availability and Readiness Assessment (SARA) 2011 and 2012

vi) Non-Communicable Diseases Survey - 2014

vii) Hospital and HC IV Census - 2014

viii) Client Satisfaction Survey - 2014

ix) Malaria Indicator Survey (MIS) 2014

x) TB Prevalence Survey (Ongoing 2015)

During this HSDP period the following major surveys are planned; the UDHS-16, HIV/AIDS Impact

Assessment Survey, NHA and efficiency analyses. Each program will identify and include all surveys to

be conducted in the respective M&E Plans.

3.8.2 Surveillance

The MoH undertakes disease surveillance under the; Integrated Disease Surveillance and Response

(IDSR) and active surveillance of malaria infections as outlined below.

1) Weekly Surveillance

Weekly surveillance reporting is undertaken through the routine HMIS using the weekly surveillance

report code named as HMIS 033b.Every health facility is expected to submit a weekly surveillance

report to the DHO every Monday. The areas of reporting are; Diseases of epidemic potential where

number of cases and deaths for each of the diseases is reported, Malaria case management and the

ACT stock balances and the number of Maternal and Perinatal Deaths that have occurred in the health

facility.

2) Malaria Sentinel Surveillance

Uganda Malaria Surveillance Project developed the sentinel site malaria surveillance project to

provide high quality and timely malaria surveillance data beyond the scope of the HMIS surveillance

system. The aim of this approach is to obtain high quality individual patient data from a limited number

of sites to provide accurate malaria surveillance data for quick response systems, to support ongoing

47 | P a g e

malaria control activities and strengthen HMIS at the sentinel sites. Data is aggregated, analysed and

disseminated monthly.

3.8.3 Research and Special Studies

Health Institutions are encouraged to conduct operational research. The results of these studies are

intended to inform decision making hence contribute to improving delivery of and access to health

care and nutrition services, by developing practical solutions to common, critical problems in

implementing these interventions. Operational surveys shall be carried as planned on approval by the

relevant institutions and findings disseminated through the existing structures. Operational research

shall encompass a wide range of problem-solving techniques and methods applied in the pursuit of

improved decision-making and efficiency.

Operation research (using qualitative and quantitative methodologies) should be focused on

understanding of the reasons why key targets (in particular related to RMNCAH, Malaria, TB and

HIV/AIDS) are not being met, and results be critically discussed and synthesized during mid-tern or

final review of the HSDP.

The Uganda National Health Research Organization (UNHRO) is responsible for coordinating all the

health related research in Uganda. UNHRO will be responsible for mobilizing resources, setting,

developing and disseminating health services research agenda for the 5 year period, commissioning

and organizing health research in collaboration with other research and academic institutions and

NGOs.

4 Progress and Performance Reviews Progress and performance reviews are critical for updating all stakeholders on program progress,

discussing problems and challenges, and developing a consensus on corrective measures or actions.

Progress and performance reviews are part of the governance mechanisms that help ensure

transparency and allow for debate between partners.

Figure 5 illustrates how progress and performance are assessed by annual reviews, which result in

adjustments to annual operational plans by a mid-term review, and by a final evaluation.

Figure 6: Progress and Performance Review of the National Health Strategy

Source: Monitoring and Evaluation of National Health Strategies, WHO 2011

The HSDP monitoring and review process will be interlinked across the different planning entities. This

process will be based on a national platform approach that: uses the district as the unit of design and

analysis; based on continuous monitoring of different levels of indicators; gathers additional data

before, during, and after the period to be assessed by multiple methods; uses several analytical

techniques to deal with various data gaps and biases; and includes interim and summative evaluation

analyses. This implies that information at each level will be provided from the planning entities below

it. Management support, on the other hand, as well as governance/partnership information will be

analyzed at the same level it is to be provided.

Respective reviews will be guided by information developed by the Government management

structures at each level. These will compile the review information with inputs from the other

stakeholders. All reviews will be presented and endorsed at the respective management and

partnership structures for the level. These are illustrated in the table below.

Year 1 Year 2 Year 3 Year 4 Year 5

Operational Plans

Annu

al

Annu

al

Annu

al

Progress and performance reviews and policy dialogue

Annu

al Final and situation

Data analysis and synthesis Systematic qualitative assessment

Surveys Context Facility

data Civil

registration

Administrative

data

Research Leadership Policies

49 | P a g e

Table 6: HSDP Monitoring and Review process

Process Frequency Focus Level

Progress review Quarterly Done by Joint (public + private) Performance Assessment Teams and peers per level or institution. A review of progress against planned activities and key output targets for the workplan

National Regional

District HSD Health Facility

Joint Annual review Annually Done Jointly with key stakeholders,

and planning entities as from HSD level onwards Review progress against annual output targets for the workplan and HSDP targets

National

Regional

Mid Term Review 2nd year of implementation

Done jointly with key stakeholders Review progress against targets for outcome and impact indicators, as well as contextual changes

National

End Review Last year of HSDP - June - Dec 2019

Comprehensive analysis of progress and performance. Includes results of specific research and prospective evaluations from the beginning of the HSDP

National

The performance review process will be one of the learning mechanisms in the sector. For proper

follow up and learning:

i) All performance reviews and evaluations will contain specific, targeted and actionable recommendations.

ii) All target institutions will provide a response to the recommendation(s) within a stipulated timeframe, and outlining a) agreement or disagreement with said recommendation(s), b) proposed action(s) to address said recommendation(s), c) timeframe for implementation of said recommendation(s).

iii) All institutions will be required to maintain a Recommendation Implementation Tracking Plan which will keep track of review and evaluation recommendations, agreed follow-up actions, and status of these actions.

iv) Institutions which have an oversight responsibility on the implementation of public policy will monitor the implementation of agreed actions utilizing the Recommendation Implementation Tracking Plan. These institutions are as follows: OPM overseeing MDAs, Ministries overseeing the LGs.

The budget of collating performance data and conducting sector performance reviews will be provided

for under the sector monitoring budget.

4.1 Progress review

4.1.1 Progress Review at Central Level

The Quarterly Sector Performance Review will assess progress on the quarterly work plans of MoH

departments, semi-autonomous institutions, Health Professional Councils, National Referral Hospitals

(NRHs, Mulago and Butabika Hospitals) and LGs. These quarterly reviews are focused on the indicators

and targets in the operational plans and these are mainly input, process and output indicators. The

aim of these reviews is to:

Assess progress made on action points/recommendations of previous quarterly reviews.

Assess implementation of planned activities against set targets.

Highlight budget performance during the quarter (utilization against allocation).

Propose strategies to address challenges in subsequent quarters.

This shall be carried out using a standardized reporting format (Ref. Annex 8.1) during the quarterly

performance review workshops, where reports produced by each department/institution and NRHs

will be presented and discussed in plenary sessions. The report should focus on the results achieved

against the set targets in the workplans. The meetings will be attended by representatives of all

reporting units.

The departmental and institutional reports are to be compiled into quarterly sector performance

reports which will feed into the AHSPR. The QAD will be responsible for organizing the quarterly review

meetings, compiling and disseminating the quarterly reports.

4.1.2 Progress Review at Regional Level

Regional Performance Monitoring Teams are responsible for organising quarterly performance review

workshops, where reports produced by each district in the catchment area will be presented and

discussed in plenary sessions. The meetings will be attended by representatives of all reporting

districts and key stakeholders.

These stakeholders will include;

- Members of Parliament

- LC Chairpersons

- Secretary for Health / Social Services Committee

- DHT Representatives

- Representatives of Public and private health facility managers

- Representatives of health related sectors

- Representatives of HDPs/ IPs

- Representatives of CSOs

- Community, and / or cultural leaders

MoH will provide standardized planning and reporting formats, tools and process to all the regional

coordinators, for guidance.

51 | P a g e

4.1.3 Progress Review at District Level

The DHMT shall review the district performance reports focusing on progress of implementation of

the workplans, timeliness, completeness and accuracy of the reports. The district quarterly and annual

performance reports will be presented and discussed during the quarterly district review meetings.

4.1.4 Performance Monitoring and Review at HSD Level

Like the district, each HSD Team shall review their HSD reports performance focusing on

implementation of the HSD workplans, timeliness, completeness and accuracy of the reports. The HSD

quarterly and annual performance reports will be presented and discussed during the quarterly HSD

review meetings and stakeholders’ forum (HSD / Constituency Health Assembly).

HSD stakeholders’ fora

These stakeholders include;

- Members of Parliament

- RDC

- Political, administrative and technical leadership

- Public and private health providers operating

- IPs supporting, or facilitating activities

- Critical civil society groups operating


4.1.5 Progress Review at Health Facility Level

Performance monitoring and review in health facilities (including private health facilities and

community) will be carried out using standard planning and reporting formats (Ref. Annex 8.1). During

the monthly health facility meetings performance review should focus on progress in implementation

of the workplan, timeliness, completeness and accuracy of the reports. The health facility quarterly

assessment reports will be used for performance review during the quarterly HUMC or Hospital Board

meetings. Annual report to be discussed at the annual health facility stakeholders' fora.

Health facility stakeholders’ fora

Each health facility in the country has a defined catchment area, for which it is responsible for

coordinating delivery of services. All stakeholders in the catchment area of the facility shall come

together to discuss health and health related issues affecting them at least once a year. These

stakeholders include;

- In-charges of the departments where applicable

- Community and / or political leaders


- IPs supporting, or facilitating activities

- CBOs operating

- Community Health Workers

The fora shall use health unit data to discuss performance of health within the catchment area, and

agree on priorities to guide the facility and other service providers in their respective planning and

implementation processes. In addition, the HUMCs and Hospital Boards are expected to use the M&E

results to sensitize the community and accountability through the community dialogue meetings.

4.1.6 Progress Review at Community Level

Stakeholders in the Sub counties shall come together to discuss health and health related issues

affecting their SC quarterly.

These stakeholders include;

- Political, administrative and technical leadership

- Public and private health providers

- HDPs / IPs

- Critical civil society groups


The fora shall use SC data to discuss performance within the SC, and agree on priorities to guide

facilities and other service providers in their respective planning and implementation processes. In

addition, the SCs are expected to use the M&E results to sensitize the community and accountability

through the community dialogue meetings.

4.1.7 Performance Monitoring for CSOs and Private Sector

CSOs and the private sector contribute significantly to health service delivery in the country. Most

times their input is not captured in the sector performance reports. In order to measure their

contribution to the overall sector performance they will be required to report to the relevant sector

entities (Districts / MoH programs) using the existing monitoring tools. They will as well be required

to participate in progress reviews following the above review process. The CSO and Private Providers’

umbrella bodies will play a coordination role in monitoring all CSOs and private sector providers to

ensure alignment with national priorities. MoH will support this process through providing the

necessary M&E tools.

4.2 Annual review The annual performance review will be conducted through the Joint Review Mission (JRM) which is

the national forum that brings together all relevant stakeholders in the health sector. The review is

focused on input, process, output and coverage indicators and targets specified in the annual plans.

Performance of the previous fiscal year is assessed, actions and plans for the year ahead (current

year+1) are also determined. The actions and plans should be clearly spelt out in amendments to the

HSDP operations, and the Budget Framework Papers and Ministerial Policy Statements of the Ministry.

Annual Sector Reviews should be completed by the 30th September each year, to ensure that the

findings feed into the planning and budget process of the coming year, and annual reporting to Cabinet

and Parliament. (National Policy on Public Sector Monitoring and Evaluation, October 2010). The main

purpose of the annual review is to;

(a) Receive and discuss the previous financial year sector annual performance report against

priorities.

(b) Raise and respond to issues arising from the AHSPR.

(c) Identify and agree on sector priorities for following financial year.

53 | P a g e

The annual review shall be organized by the MoH in collaboration with HDPs. The participants include;

key Policy makers (Parliamentary Social Services Committee), Health Service Commission, key MoH

staff and departments, Professional Councils, representatives of LGs, other Health Related Ministries

(e.g. MoFPED, MoLG, MoPS, Ministry of Education and Sports, Ministry of Lands, Water and

Environment, Ministry of Agriculture, Animal Industries and Fisheries, Ministry of Gender, Labour and

Social Development), UN agencies, DPs, non-state implementing partners (PNFPs, CSOs, private

providers), representatives of Health Consumers Organizations and CSO advocacy organizations.

The proceedings of the JRM will be documented in the Aide Memoire to be signed by the MoH, DPs,

Private Sector and CSOs. The budget for conducting annual sector reviews will be provided for under

the sector monitoring budget.

4.3 Mid Term Review A Mid-Term review of the HSDP 2015/16 – 2019/20 will be conducted after the second year (2016/17)

of implementation and report presented at the JRM. The purpose of the MTR is to review the progress

of implementation; identify and propose adjustments to the HSDP and other government policies as

required. The analysis will focus on progress of the entire sector against planned impact, but will also

include an assessment of inputs, processes, outputs and outcomes, using the HSDP indicators (key and

others). The main result will be a list of recommendations for the remaining HSDP years. The MTR

performance shall be used to review the HSDP key indicators for the remaining HSDP implementation

period. This will be an internal, joint exercise involving all stakeholders. External expertise may be

sought to support some aspects of the review process.

4.4 End Term Review The HSDP final evaluation will be conducted in the final year of implementation (2019/20). The

findings and recommendations will be used for the formulation of the next strategic plan. The analysis

will focus on progress of the entire sector against planned impact and will also include an assessment

of inputs, processes, outputs and outcomes, using the HSDP indicators (key and others). It will focus

on expected and achieved accomplishments, examining the results chain, processes, contextual

factors and causality, in order to understand achievements or the lack thereof. The evaluation will

have to answer questions of attribution (What made the difference?) and counterfactual (what would

have happened if we had not done A or B?) and take into account contextual changes (economic

growth, social changes, environmental factors etc.), as well as policies and resource flows. The reviews

will be conducted by a team of independent in-country institutions in close collaboration with

international consultants. The End Term Evaluation findings shall guide the development of the

subsequent HSDP.

4.5 Linkages between health sector reviews, program / project specific

reviews, and global reporting

4.5.1 Program / project specific reviews

Detailed program / project specific reviews shall be linked to the overall health sector review and

contribute to it. Program / project specific reviews shall be conducted prior to the overall health sector

review, and help inform the content of the health sector review in relation to that specific program

area. To ensure credibility and an objective view of progress, the specific program reviews will involve

all stakeholders.

4.5.2 Global reporting

Global reporting requirements shall be based on ongoing country processes of data generation,

compilation, analysis and synthesis, communication and use for decision making. This has been clearly

spelt out in the Country Compact for implementation of the HSDP. The common M&E platform (See

Figure 7) serves as the guide for all M&E related processes such as the health sector component of

the Sector Wide Approaches (SWAp) and IHP+, for program activities supported by Global Funding

Agencies e.g. GAVI, the Global Fund for TB, AIDs and Malaria, and other DPs, and for disease and

program / project specific needs.

Figure 7: Country-led platform for monitoring & review of the national health strategy

Source: WHO 2011

Country data Information generation

Analysis and synthesis

Data quality assessment

Ind

epe

nd

ent

revi

ew

s

Statistical

repo

rts

Programme reports

Monitoring reports

Review

s

Re

view

s

SDG / UN

Reporting

Program

Reporting

e.g TB,

RMNCAH,

HIV, etc

Evaluation

GAVI

Reporting

Global Fund

Reporting

PEPFAR

Reporting

External validation and estimates Common standards and tools

Minimization of

reporting requirements Harmonization of

reporting requirements

55 | P a g e

4.6 Decision-making processes and tools for remedial action 4.6.1 Decision-making processes

The outcomes of the review process will be used to guide decision making during planning, resource

mobilisation and allocation, accountability, policy dialogue, review and development.

1. Planning

Periodically, the achievements, best practices and challenges identified during the review process

will be used to determine priorities for the subsequent planning period and set new performance

targets.

2. Resource Mobilization and Allocation

The MoH will move towards evidence based priority setting to guide resource mobilisation and more

effective and efficient resource allocation levels, rather than proportionate allocation of resources.

Other approaches like Results Based Financing which relies on quality data, will be institutionalized.

3. Accountability

All public and private institutions will be held accountable for the achievement of targets set and

agreed upon annually as documented in policy statements and work plans. These achievements will,

where appropriate, include targets linked to the charters and service delivery standards. For instance,

at the HSD level, a new concept of Constituency /HSD Task Forces will be rolled out in the country; all

HSDs will be required to hold biannual assemblies where they will present and discuss their

performance with key stakeholders.

4. Policy Dialogue, Review and Development

At national level policy issues / problems are raised through reports presented by SMC to HPAC which

meets every two months. At district and sub-county level technical committees will be responsible for

generating policy issues / problems for discussion during the Technical Planning Committee meetings

and forwarding to the respective Local Council (LC) Committees. The LC will be responsible for

analyzing and making policy recommendations to the District / Sub-county Council. The policy analysis

process shall take into consideration the "Wants", "Needs" and "Feasibility" of strategic interventions.

The findings shall be packaged to enable policy dialogue, review and development.

5 Implementation Plan M&E is not only a semi-annual or quarterly event, but a set of activities all of which provide data, which add to the periodic data collections, reviews and data

use. The implementation plan is annualized for the key M&E activities, showing the responsible persons or departments and frequency of the activities.

Table 7: M&E Implementation Plan

Activity Responsible

Person/Department

Frequency

2015/16 2016/17 2017/18 2018/19 2019/20

Compilation and

submission of

reports

Provide the data collection tools ACHS HID Ongoing Ongoing Ongoing Ongoing Ongoing

Weekly Surveillance data Surveillance Focal Person Weekly Weekly Weekly Weekly Weekly HMIS 105 (OPD) & HMIS 108 (Inpatient)

HMIS 123 (District OPD) & HMIS 124 (District

Inpatient) Births and deaths report

Health Unit I/C

HSD I/C, DHO

Monthly Monthly Monthly Monthly Monthly

HMIS 106a Health Facility Manager Quarterly Quarterly Quarterly Quarterly Quarterly Annual Health Unit performance report (HMIS 107) Health Facility Manager July July July July July

Annual District performance report (HMIS 127) DHO July July July July July

OBT (Financial performance) Report All Accounting Officers Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly sector performance report CHS QAD Quarterly Quarterly Quarterly Quarterly Quarterly

Annual program / project reports Program Managers July July July July July Annual Sector Statistical Abstract ACHS HID Sept Sept Sept Sept Sept

Annual health sector performance report DGHS Sept Sept Sept Sept Sept

Annual Government Performance Report Director Planning Sept Sept Sept Sept Sept Annual sector performance report for the NDP Director Planning Sept Sept Sept Sept Sept

Data Quality

Assurance

Health Facility Data verification Facility Manager/ HSD

Manager / DHO


District Data Quality Audit ACHS HID Quarterly Quarterly Quarterly Quarterly Quarterly Data Quality Assessment and Adjustment University May May May May May

Feedback Feedback to all reporting entities on reports submitted

to higher levels

All Facility / M&E Officers

ACHS HID


Performance

Reviews

Performance Review meetings HSD Manager/ DHO / RPMTs /

CHS QAD

Quarterly Quarterly Quarterly Quarterly Quarterly

Program review meetings Program Managers Annual Annual Annual Annual Annual

57 | P a g e

Activity Responsible

Person/Department

Frequency

2015/16 2016/17 2017/18 2018/19 2019/20

Technical Review Meeting CHS P April April April April April

Joint Review Mission DGHS Sep Sep Sep Sep Sep

Conduct Surveys Service Availability Readiness Assessment CHS QA May - June May - June

Efficiency analysis ACHS B&F Apr - Jun Apr - Jun Apr - Jun Apr - Jun Apr - Jun

National Health Accounts CHS P Jul - Dec Jul - Dec Jul - Dec Jul - Dec Jul - Dec HIV/AIDS Epidemiological Surveillance PM ACP Annual Annual Annual Annual Annual HIV/AIDS Indicator Survey ACHS CD Feb to Jun

National Client Satisfaction Survey QAD Jan Jan

Uganda Demographic Health Survey-6 UBOS Jan - Jun

Panel Survey (Annual) UBOS Jul - Dec Jul - Dec Jul - Dec Jul - Dec Jul - Dec

National Household Survey (Every 3 years) UBOS Jul - Dec Jul - Dec

National Service Delivery Survey (Every 5 years) UBOS Jul to Dec

Evaluations Specific program / project evaluations (Baseline, Mid &

End Term)

Program/ Project Managers Ongoing Ongoing Ongoing Ongoing Ongoing

HSDP Mid Term Review DGHS Sept to April

HSDP End Term Evaluation DGHS Jan to Jun

Capacity Building Printing of the HSDP M&E Plan ACHS QA April

Dissemination of the HSDP M&E Plan ACHS QA May - Dec

Conduct Data Use Workshop ACHS HID Annual Annual Annual Annual Annual

Conduct M&E in-service training and mentorship at all

levels

ACHS QA / HID / RPMTs /

Managers / DHO

Ongoing Ongoing Ongoing Ongoing Ongoing

Recruitment and deployment of required human

resource for effective M&E at all levels.

HSC / DSC Ongoing Ongoing Ongoing Ongoing Ongoing

M&E Plan

Monitoring &

Evaluation

SME&R TWG meetings CHS QA Monthly Monthly Monthly Monthly Monthly

M&E technical supervision to Institutions and LGs ACHS QA / HID / RPMTs /

M&E Officers / DHO

Quarterly Quarterly Quarterly Quarterly Quarterly

M&E Stakeholders meetings CHS QA / HID / RPMTs / DHOs Jul Jul Jul Jul Jul

Assessment of the M&E Plan implementation CHS QA April - Jun April - Jun

6 Monitoring the Implementation of the M&E Plan for the HSDP Existing sector M&E structures (Ref. to chapter 2.2 - roles and responsibilities) will be used for

monitoring implementation of the M&E Plan for the HSDP. Support supervision, meetings and periodic

reports will be used for monitoring at the various levels as outlined below.

At national Level:

1. Monthly SME&R TWG meetings will be carried out to track progress on implementation of the

M&E Plan.

2. Quarterly M&E technical supervision to institutions and LGs.

3. Quarterly M&E progress reports to be presented at the sector review meetings.

4. Annual M&E stakeholders meetings.

5. Mid-term assessment and end evaluation of the implementation of HSDP M&E plan.

At district Level:

1. Monthly District Health Team Meetings to track progress on implementation of the district M&E

plan.

2. Quarterly DHT supervision to HSDs

3. Quarterly DHMT performance review meetings

At Health Sub-District level:

1. Monthly HSD Team Meetings to track progress on implementation of the HSD M&E plan.

2. Quarterly HSD supervision to health facilities.

3. Quarterly HSD Team performance review meetings.

At facility level:

1. Monthly health facility meetings to track progress on implementation of the facility workplan.

2. Quarterly health facility meetings.

3. Quarterly supervision to VHTs and CHEWs.

At community level:

1. Quarterly CHEW and VHT review meetings.

59 | P a g e

6.1 M&E Plan Implementation Monitoring Indicators The indicators and levels of reporting for monitoring implementation of this M&E Plan are shown in

the table below;

No. Indicator Level of reporting

1. % of period reports (weekly, quarterly, annual compiled and

submitted timely

All levels

2. % of monthly and quarterly HMIS reports verified by the

Health Facility In-charges before submission to the

DHO/MoH.

Facility

3. % of quarterly data validations conducted. National and district

4. % of districts providing quarterly feedback to health facilities. District / HSD

5. % of quarterly feedback reports to districts. National

6. % of planned performance reviews conducted. All levels

7. Number /% of planned evaluations conducted and

disseminated.

National

8. % of districts oriented on the M&E Plan for the HSDP

(dissemination).

National

9. Number of health workers receiving in-service training

(workshops, seminar or CMEs) in M&E.

All levels

7 Budget Cost estimates for implementation of the M&E plan are based on the HSDP costs estimates for M&E.

Costs for managing the health information systems infrastructure are captured under the HMIS

Strategic Plan by the MoH/HID and respective health information systems (HRIS, SCMS) budgets. Over

the 5-year period, an estimated total of UGX 89,653,447,000/- will be required for implementation of

this plan. Of this 35.4% is required for compilation and submission of performance reports, 31.5% for

performance reviews and 23% for surveys (Table 8). The detailed budget is in Annex 8.2.

The funds for the Plan implementation will be managed under the responsible departments, programs, districts and stakeholders.

Table 8: Budget Summary for the M&E plan activities

Activity Amount UShs. '000 Total %

2015/16 2016/17 2017/18 2018/19 2019/20 UGX USD

Compilation and submission of

performance reports

6,043,205 6,194,285 6,349,142 6,507,871 6,670,568 31,765,071 8,823.63 35.4%

Data Quality Assurance &

feedback

123,760 126,854 190,025 133,276 199,608 773,524 214.87 0.9%

Performance Reviews 5,469,000 5,349,475 5,745,712 5,620,292 6,036,424 28,220,904 7,839.14 31.5%

Surveys 8,012,600 2,984,915 3,159,538 3,136,026 3,324,427 20,617,506 5,727.09 23.0%

Evaluations 200,000 200,000 500,000 200,000 550,000 1,650,000 458.33 1.8%

Dissemination 648,600 664,815 701,435 698,471 735,933 3,449,255 958.13 3.8%

Capacity Building 469,000 316,000 181,200 187,430 195,691 1,293,321 359.26 1.4%

Monitoring & Evaluation 358,400 367,360 376,544 385,958 395,607 1,883,868 523.30 2.1%

Total 21,324,565 16,203,704 17,203,597 16,869,324 18,108,257 89,653,447 24,903.74 100%

Exchange USD: UShs. 1:3,400

I | P a g e

8 Annex

8.1 Quarterly Output Report Format for the Workplans & Budgets

Output Code Output

Description

Planned Annual

Outputs

Planned Output

Target (Qty and

Location)

Planned

Expenditure

(Ush)

Actual Output (Qty

and Location)

Actual

Expenditure (Ush)

Reasons for

variation in

performance

I | P a g e

8.2 Detailed 5 Year Budget for Implementation of the Plan

Activity Output Indicator Target Unit Cost

UGX '000

No. of

Units

Amount UGX. '000 Total

2015/16 2016/17 2017/18 2018/19 2019/20

Compilation and submission of performance reports

HMIS tools (registers & report

forms)

No. of tools printed 1 6,000,000 1 6,000,000 6,150,000 6,303,750 6,461,344 6,622,877 31,537,971

Compile Annual project reports No. of annual reports 20 15.00 10 3,000 3,075 3,152 3,231 3,311 15,769

Compile & submit Annual Central

Level performance report (OBT)

No. of annual reports 20 10 1 200 205 210 215 221 1,051

Compile & submit Annual health

sector performance report

Annual Report 1 40,000 1 40,000 41,000 42,025 43,076 44,153 210,253

Compile & submit statistical abstract No. of Reports 1 5 1 5 5 5 5 6 26

Subtotal 6,043,205 6,194,285 6,349,142 6,507,871 6,670,568 31,765,071

Data Quality Assurance

Health Facility Data Quality Audit No. of reports 4 150 112 67,200 68,880 70,602 72,367 74,176 353,225

District Data Validation in selected

districts

No. of reports 4 700 20 56,000 57,400 58,835 60,306 61,814 294,354

Data Quality Assessment and

Adjustment

No. of reports 1 60,000 1 0 60,000 63,000 123,000

Subtotal 123,200 126,280 189,437 132,673 198,990 770,580

Feedback

Routine feedback to sub-national

and key stakeholders on reports

submitted to Resource Center -

Quarterly

No. of feedback

reports to all

stakeholders

4 1 140 560 574 588 603 618 2,944

Subtotal 560 574 588 603 618 2,944

Performance Reviews

Quarterly Health Facility Review

meetings

No. of meetings 4 100 3,500 1,400,000 1,435,000 1,470,875 1,507,647 1,545,338 7,358,860

Quarterly Sub County Review

meetings

No. of meetings 4 250 1,117 1,117,000 1,144,925 1,173,548 1,202,887 1,232,959 5,871,319

Quarterly HSD Review meetings No. of meetings 4 1,000 238 952,000 975,800 1,000,195 1,025,200 1,050,830 5,004,025

Quarterly District Review meetings No. of meetings 4 2,000 120 960,000 984,000 1,008,600 1,033,815 1,059,660 5,046,075


UGX '000

No. of

Units


2015/16 2016/17 2017/18 2018/19 2019/20

Quarterly Regional Review

meetings

No. of meetings 4 5,000 12 240,000 246,000 252,150 258,454 264,915 1,261,519

Quarterly Sector Performance

review meetings

No. of meetings 4 25,000 1 100,000 102,500 105,063 107,689 110,381 525,633

Technical Review Meeting No. of meetings 1 50,000 1 50,000 51,250 52,531 53,845 55,191 262,816

Joint Review Mission No. of JRM 1 400,000 1 400,000 410,000 420,250 430,756 441,525 2,102,531

National Health Assembly No. of NHA 1 250,000 1 250,000 0 262,500 0 275,625 788,125

Subtotal 5,469,000 5,349,475 5,745,712 5,620,292 6,036,424 28,220,904

Surveys

ANC Sentinel Surveillance (HIV) No. of reports 1 50,000 1 50,000 51,250 52,531 53,845 55,191 262,816

HIV/AIDS Indicator Survey Survey report 1 5,000,000 1 5,000,000 0 0 0 0 5,000,000

SARA Survey report 1 120,000 1 120,000 123,000 126,075 129,227 132,458 630,759

Health Facility Quality of Care

Assessments

Report 1 23,000 112 2,576,000 2,640,400 2,706,410 2,774,070 2,843,422 13,540,302

Health Facility Client Satisfaction

Surveys (Hospitals & HC IVs)

CSS Report 1 200 333 66,600 68,265 69,972 71,721 73,514 350,071

National Client Satisfaction Survey NCSS Report 1 100,000 1 100,000 0 100,000 0 110,000 310,000

Other operational surveys Reports Assorted 10,000 10 100,000 102,000 104,550 107,164 109,843 523,557

Subtotal 8,012,600 2,984,915 3,159,538 3,136,026 3,324,427 20,617,506

Evaluations

Specific program / project

evaluations

No. of evaluations Assorted 100,000 10 200,000 200,000 200,000 200,000 200,000 1,000,000

HSDP Mid Term Review MTR 1 300,000 1 0 300,000 0 0 0 300,000

HSDP End Term Evaluation ETR Report 1 350,000 1 0 0 0 0 350,000 350,000

Subtotal 200,000 200,000 500,000 200,000 550,000 1,650,000

Dissemination

Weekly surveillance bulletins No. of bulletins

disseminated

52 1,000 12 624,000 639,600 655,590 671,980 688,779 3,279,949

Quarterly performance reports No. of reports printed

& disseminated

200 20 1 4,000 4,100 4,203 4,308 4,415 21,025

Annual Health Sector Performance

Report

AHSPR printed &

disseminated

1 20 1,000 20,000 20,500 21,013 21,538 22,076 105,127

III | P a g e


UGX '000

No. of

Units


2015/16 2016/17 2017/18 2018/19 2019/20

Mid term review Report MTR printed &

disseminated

1 20 1,000 0 0 20,000 0 0 20,000

End Term Evaluation Report printed

and disseminated

ETE Report

disseminated

1 20 1,000 0 0 0 0 20,000 20,000

Survey Reports No. of survey reports

disseminated

Assorted 20 30 600 615 630 646 662 3,154

Subtotal 648,600 664,815 701,435 698,471 735,933 3,449,255

Capacity Building

Printing of the HSDP M&E Plan No. of plans printed 1 25 6,000 150,000 0 0 0 0 150,000

Develop and print an indicator

booklet

Booklet developed 1 10 1,000 10,000 0 0 0 0 10,000

Orientation and Dissemination of the

M&E Plan at district level

No. of dissemination

meetings

1 2,500 112 140,000 140,000 0 0 0 280,000

In-service training in M&E No. of health workers

trained

112 500 1 56,000 58,000 60,000 62,000 64,000 244,000

National Data use workshop Workshop conducted 1 65,000 1 65,000 70,000 72,000 75,000 80,000 362,000

Vehicle Maintenance and Operation No. of vehicles

maintained

12 1,000 4 48,000 48,000 49,200 50,430 51,691 247,321

Birth and Death registration (MVRS) No. of health workers

trained

500 125 100 12,500 12,500 12,500 12,500 12,500 62,500

Subtotal 481,500 328,500 193,700 199,930 208,191 1,355,821

Monitoring & Evaluation

M&E technical supervision and

mentoring to Institutions and LGs

No. of reports 4 800 112 358,400 367,360 376,544 385,958 395,607 1,883,868

Subtotal 358,400 367,360 376,544 385,958 395,607 1,883,868

Total 21,337,065 16,216,204 17,216,097 16,881,824 18,120,757 89,715,947

8.3 District League Table Indicators Indicator Category

Indicator National Baseline

Target 2019/20

Human Resources

1. Approved posts filled with qualified personnel in public health facilities (%)

71% (2014/15)

80%

Service quality 2. Facility based fresh still births (per 1,000 deliveries)

16 / 1,000 (2013/14)

11/1,000

3. Maternal deaths reported which are audited / reviewed (%)

33% (2012/13)

65%

4. TB Treatment Success Rate (%) 79% (2013 cohort)

90%

5. Patients diagnosed with malaria that are laboratory confirmed (%)

NA 100%

Coverage of interventions

6. PCV3 Coverage (%) 79% (2014/15)

94%

7. ANC 4 (%) 36.6% (2014/15)

47.5%

8. IPT3+ (%) NA

93%

9. HIV+ women receiving ARVs for eMTCT during pregnancy & delivery (%)

72% (2013/14)

95%

10. Deliveries in facilities (%) 52.7% (2014/15)

64%

11. Latrine Coverage (%) 77% (2014/15)

82%

Health Information

12. Timeliness of HMIS (105) reporting (%) 88% (2014/15)

97%

13. Completeness of HMIS report 105 (%) 83% (2014/15)

97%

Management 14. Timeliness of quarterly district financial reporting (%)

NA 60%

15. Average district quality of care score (%) NA 75%

V | P a g e

8.4 Indicator Definitions for the HSDP Key Performance Indicators 1. Maternal Mortality Ratio

Definition: Annual number of female deaths from any cause related to or aggravated by

pregnancy or its management (excluding accidental or incidental causes) during

pregnancy and childbirth or within 42 days of termination of pregnancy,

irrespective of the duration and site of the pregnancy, per 100 000 live births,

for a specified time period.

Numerator: Number of maternal deaths

Denominator: Number of live births

Calculation: Numerator

__________________ x 100, 000

Denominator

Data Sources: Household surveys – e.g. UDHS

Frequency of

Analysis,

Interpretation

and Response

Every 5 years

Disaggregation By age and parity, location (major regions), and socio-economic characteristics

(e.g. education level, wealth quintile).

2. Neonatal Mortality Rate

Definition: Number of deaths during the first 28 completed days of life per 1000 live births

in a given year or other period.

Numerator: The number of neonatal deaths in a given period

Denominator: The total number of live births surveyed


__________________ x 1,000

Denominator

Data Sources: Household surveys – e.g. UDHS.

Frequency of

Analysis,

Interpretation

and Response

Every 5 years

Disaggregation By sex, location (major regions), and socio-economic characteristics (e.g.

mother’s education level, wealth quintile).

3. Infant Mortality Rate

Definition: Probability of a child born in a specific year or period dying before reaching the

age of one, if subject to age-specific mortality rates of that period.

Numerator: The number of infant deaths

Denominator: The total number of live births that year


__________________ x 1,000

Denominator Data Sources: Household surveys – e.g. UDHS.

Frequency of

Analysis,

Interpretation

and Response

Every 5 years

Disaggregation By sex, location (major regions), and socio-economic characteristics (e.g. mother’s

education level, wealth quintile).

4. Under Five Mortality Rate

Definition: Probability of a child born in a specific year or period dying before reaching the

age of five, if subject to age-specific mortality rates of that period. Numerator: The number of under five deaths in a given period

Denominator: The total number of live births surveyed.


__________________ x 1,000

Denominator


Frequency of

Analysis,

Interpretation

and Response

Every 5 years

Disaggregation By sex, location (major regions), and socio-economic characteristics (e.g. mother’s

education level, wealth quintile).

5. Total Fertility Rate

Definition: The number of live births per 1000 women in a specific age group for a specified geographic area and for a specific point in time

Numerator: Number of live births to women in specified age group

Denominator: Number of women in same age group


__________________ x 1,000

Denominator


Frequency of

Analysis,

Interpretation

and Response

Every 5 years

Disaggregation By location (major regions), and socio-economic characteristics (e.g. education

level, wealth quintile).

6. Adolescent Pregnancy (Fertility) Rate (per 1,000 women)

Definition: Number of live births to adolescents (women 15-19 years) per 1,000 in that

age group.

Numerator: Number of live births to adolescents (women 15-19 years) in a specified period

Denominator: Number of adolescents (women 15-19 years) in a specified period


__________________x 1,000

Denominator

VII | P a g e


Frequency of

Analysis,

Interpretation

and Response

Every 5 years

Disaggregation By location (major regions), and socio-economic characteristics (e.g. education

level, wealth quintile).

Financial risk protection

1. Out of pocket health expenditure (payment) for health as a % of Total Health Expenditure

Definition: Share of total current expenditure on health paid by households out-of-pocket

(expressed as a % of total current expenditure on health, this is the households’

out-of-pocket expenditure)

Numerator: Total current expenditure on health paid by households out-of-pocket

Denominator: Total current expenditure on health (all sources)


__________________ x 100

Denominator Data Sources: Household surveys – e.g. UDHS.

Frequency of

Analysis,

Interpretation

and Response

Every 2 years

Disaggregation Financing source institutional unit, Disease, Input, Sub-National Level , Socio-

economic status

OUTCOME

1. ANC 4 Coverage

Definition: Percentage of women aged 15-49 with a live birth in a given time period that

received antenatal care four times.

Numerator: Number of pregnant women that received antenatal care at least four times in a

given period.

Denominator: Number of expected pregnancies in the catchment area in a given period.


__________________ x 100

Denominator

Data Sources: Health service statistics: - HMIS

Household surveys – that can generate this indicator includes UDHS, Multiple

Indicator Cluster Surveys (MICS), Fertility and Family Surveys, Reproductive Health

Surveys (RHS) and other surveys based on similar methodologies. The UDHS uses

a different indicator definition targeting women aged 15 – 49 years with full term

birth in a given period bay taking birth history. However, in Uganda a number of

young girls are giving birth below the age of 15 years and there are also women

older than 49 years giving birth.

Frequency of

Analysis,

Interpretation

and Response:

The frequency of data collection should be daily, with monthly summaries and

monthly reporting within the schedule of the HMIS. (Health Unit Monthly Report,

Health Unit Quarterly Assessment Report, Health Unit Annual Report).

Surveys - Every 3 – 5 years

Disaggregation: By location (urban/rural, major regions), level of care, parity and socio-economic

characteristics (e.g. mother’s education level, wealth quintile).

2. Health Facility (Institutional) Deliveries

Definition: The proportion of births / deliveries in public and private health facilities.

Numerator: Number of births / deliveries in public and PNFP health facilities.

Denominator: Total number of expected births / deliveries in the same period.


__________________ x 100

Denominator

Data Sources: Health service statistics: As the point of contact with women, this is the main and

most obvious routine source of information for the numerator however it

excludes deliveries conducted by Private Health Providers not reporting through

the HMIS. The results from the health service statistics should be validated against

the UDHS results.

Population Surveys e.g. UDHS.

Census: Health service information cannot provide accurate size of the

denominator population. Projections or in some cases vital registration data are

used to provide the denominator (number of live births). Frequency of

Analysis,

Interpretation

and Response


monthly reporting within the schedule of the HMIS.

Analysis, interpretation and response should be done monthly, quarterly and

annually.

Disaggregation By facility level, facility ownership, type of skilled health personnel, location

(urban/rural, districts, regions), parity and socio-economic characteristics (e.g.

mother's education, wealth quintile).

3. DPT3Hib3Heb3 coverage

Definition: The percentage of under one-year olds who have received three valid doses of the

combined DPTHibHeb vaccine in a given year.

Numerator: Number of under one year old who have received the 3rd valid dose of DPTHibHeb

vaccine.

Denominator: Number of children under one year in the target population in one year period.


__________________x 100

Denominator

Data Sources: Health service statistics - HMIS. The results from the health service statistics

should be validated against the UDHS results.

Household surveys: The principle types of surveys are the Expanded Program on

Immunization (EPI) 30-cluster survey, the UNICEF MICS, and the UDHS.

IX | P a g e

Census: Projections or in some cases vital registration data are used to provide the

denominator (number of children under one year in the target population).

Frequency of

Analysis,

Interpretation

and Response:




annually.

Disaggregation: By sex, location (urban/rural, districts, regions) and socio-economic characteristics

(e.g. mother's education, wealth quintile).

4. Measles coverage under 1 year

Definition: The percentage of children under one year of age who have received at least one

valid dose of measles containing vaccine in a given year.

Numerator: Number of children under one year who have received at least one valid dose of

measles vaccine.

Denominator: Number of children under one year in the target population in one year period.


__________________x 100

Denominator



Household surveys: The principle types of surveys are the Expanded Program on

Immunization (EPI) 30-cluster survey, the UNICEF MICS, and the UDHS.

Census: Projections or in some cases vital registration data are used to provide

the denominator (number of children under one year in the target population).

Frequency of

Analysis,

Interpretation

and Response:




annually.

Disaggregation: By sex, location (urban/rural, districts, regions) and socio-economic characteristics


5. Malaria cases per 1,000 persons per year

Definition: Number of confirmed reported malaria (microscopy or RDT) cases per 1000

persons per year.

Numerator: Number of confirmed reported malaria (microscopy or RDT) in a year

Denominator: Population in specified geographical location


__________________x 1000

Denominator

Data Sources: Health service statistics - HMIS.

Frequency of

Analysis,

Interpretation

and Response:




annually.

Disaggregation: Age, sex, place of residence, season (year and month)

6. Under five Vitamin A second dose coverage

Definition: Percentage of children 6 – 59 months who received 2 age-appropriate doses of

vitamin A in the past 12 months.

Numerator: Number of children 6 – 59 months who received 2 age-appropriate doses of vitamin A in the past 12 months.

Denominator: Number of children 6 - 59 months in the target population in one year period


__________________ x 100

Denominator



Household surveys: e.g. UDHS.

Frequency of

Analysis,

Interpretation

and Response:




annually.

Disaggregation: By sex, location (urban/rural, districts, regions) and socio-economic

characteristics (e.g. mother's education, wealth quintile).

7. Intermittent Presumptive Treatment 3 or more doses coverage for pregnant women

Definition: The proportion of pregnant women attending antenatal care who have received

the 3 or more doses of Sulphadoxine / Pyrimethamine for malaria prophylaxis

during the last pregnancy.

Numerator: Number of pregnant women who received 3 or more doses of Sulphadoxine /

Pyrimethamine for malaria prophylaxis during the last pregnancy.

Denominator: Number of first antenatal clinic visits during a specified time


__________________x 100

Denominator



Household surveys: e.g. UDHS.

Frequency of

Analysis,

Interpretation

and Response:




annually.

Disaggregation: By sex, location (urban/rural, districts, regions), parity and socio-economic

characteristics (e.g. mother's education, wealth quintile).

8. TB Case Detection Rate

Definition: Proportion of estimated new and relapse TB cases detected in a given year.

Numerator: Number of new TB cases detected / notified in a given year / period.

Denominator: Total catchment population


__________________x 100,000

Denominator

Data Sources: Health service statistics: - HMIS

XI | P a g e

Frequency of

Analysis,

Interpretation

and Response:




annually.

Disaggregation: By sex, age, location (urban/rural, subcounties, districts, regions) and socio-

economic characteristics (e.g. education, wealth quintile).

9. Anti-Retroviral Therapy Coverage

Definition: The percentage of adults and children with advanced HIV infection currently

receiving antiretroviral combination therapy in accordance with the nationally

approved treatment protocols (or WHO/UNAIDS standards) among the estimated

number of adults and children with advanced HIV infection.

Numerator: Number of adults and children eligible for ART who are currently receiving ARV in

accordance with the nationally approved treatment protocol at the end of the

reporting period.

Denominator: Estimated number of adults and children eligible for ART

(The denominator of the coverage estimate is obtained from models that also

generate the HIV prevalence, incidence and mortality estimates)


__________________ x 100

Denominator

Data Sources: Health service statistics - HMIS

Estimates for the denominator based on modeling

Frequency of

Analysis,

Interpretation

and Response:




annually.

Disaggregation: By sex, Age, Key populations, pregnant women, Persons newly initiated on ART

during the last year, provider type (public/private).

10. HIV + pregnant women not on HAART receiving ARVs for eMTCT during pregnancy, labour,

delivery and postpartum

Definition: Percentage of HIV-infected pregnant women not on HAART provided with ARV

drugs to reduce the risk of mother-to-child transmission during pregnancy, labour,

delivery and postpartum in a specified period.

Numerator: Number of HIV-infected pregnant women not on HAART provided with ARV

drugs to reduce the risk of mother-to-child transmission during pregnancy,

labour, delivery and postpartum in a specified period.

Denominator: Number of HIV-infected pregnant women not on HAART in a specified period.


__________________x 100

Denominator

Data Sources: Health service statistics – HMIS

Frequency of

Analysis,



Interpretation

and Response:


annually.

Disaggregation: By age, location (urban/rural, districts, regions), socio-economic characteristics

(e.g. education, wealth quintile) and provider type (public/private).

11. Contraceptive Prevalence Rate

Definition: The proportion of women aged 15 – 49 years, married or in union, who are using

or whose partner is using at least one method of contraception, regardless of the

method used.

Numerator: Number of women in reproductive age (15 – 49) who are married or in union and

are currently using any method of contraception in a given period.

Denominator: Total number of women in reproductive age (15 – 49) who are married or in union

in a given period.


__________________x 100

Denominator

Data Sources: Household surveys (such as UDHS, MICS).

Frequency of

Analysis,

Interpretation

and Response:

Every three to five years.

Disaggregation: By age, method of contraception, location (urban/rural, major regions), and socio-

economic characteristics (e.g. education level, quintile).

12. Couple Years of Protection

Definition: The estimated protection provided by family planning (FP) services during a one-

year period, based upon the volume of all contraceptives sold or distributed free

of charge to clients during that period.

Calculation: The CYP is calculated by multiplying the quantity of each method distributed to

clients by a conversion factor (Ref. Annex 8.4), to yield an estimate of the

duration of contraceptive protection provided per unit of that method. The CYPs

for each method are then summed over all methods to obtain a total CYP figure.

Data Sources: Health service statistics: HMIS or Supply Chain Management Information System

Frequency of

Analysis,

Interpretation

and Response:




annually.

Disaggregation: By method, location (urban/rural, districts, regions) level and type of facility.

RISK FACTORS

1. Latrine Coverage

Definition: The percentage of the households using proper excreta disposal facilities.

Numerator: Number of households using proper1 excreta disposal facilities.

1 Proper excreta disposal facilities include: Flush or pour-flush to piped sewer system, septic tank or Pit latrine

(Ventilated improved, with san-plat, with slab, ecological sanitation toilets, composting toilet).

XIII | P a g e

Denominator: Number of households in catchment.


__________________x 100

Denominator

Data Sources: Administrative reporting - using the Environmental Health Assessment Book.

Verified with the survey results.

Household surveys – These include National Household Survey.

Population census – Provides the estimates on number of households which is the

denominator.

Frequency of

Analysis,

Interpretation

and Response:

Annually

Disaggregation: By location (urban and rural, district) and socio-economic characteristics of head

of household (e.g. education level, wealth quintile).

2. Villages/ wards with a functional VHT

Definition: The percentage of villages / wards with functional2 VHTs.

Numerator: Number of villages / wards with functional VHTs in the catchment under

consideration.

Denominator: Number of villages / wards in the catchment under consideration.


__________________x 100

Denominator

Data Sources: Health Service Statistics - Community HMIS

Frequency of

Analysis,

Interpretation

and Response:

Analysis, interpretation and response should be done quarterly and annually.

Disaggregation: By location (subcounty, district, urban/rural)

3. Children below 5 years who are stunted

Definition: Percentage of stunting (height-for-age less than -2 standard deviations of the

WHO Child Growth Standards median) among children below five years (aged 0-4

years)

Numerator: Number of children below 5 years (aged 0-4 years) that fall below minus two

standard deviations from the median height-for-age during a specified period.

Denominator: Total number of children below 5 years (aged 0-4 years) that were measured

during a specified period.


__________________x 100

Denominator

Data Sources: Household surveys – UDHS

Specific population surveys – national nutrition surveys

2 VHT Functionality: VHTs submitting reports through the Community HMIS.

Frequency of

Analysis,

Interpretation

and Response:

Every 5 years

Disaggregation: By sex, age, location (urban/rural, major regions, districts) and socio-economic

characteristics (e.g. education level, wealth quintile).

4. Children below 5 years who are under weight

Definition: Percentage of underweight (weight-for-age less than 2 standard deviations of the

WHO Child Growth Standards median among children below 5 years (0 – 4 years). Numerator: Number of children below 5 years (0 – 4 years) that fall below minus two standard

deviations from the median weight-for-age during a specified period.

Denominator: Total number of children below 5 years (0 – 4 years) that were weighed during a

specified period.


__________________x 100

Denominator

Data Sources: Household surveys – UDHS

Specific population surveys – national nutrition surveys

Frequency of

Analysis,

Interpretation

and Response:

Every 5 years

Disaggregation: By sex, age, location (urban/rural, major regions, districts), and socio-economic

characteristics (e.g. education level, wealth quintile).

Service access and availability

1. New OPD utilization rate

Definition: The number of new outpatient visits3 during a specified period relative to the total

population of the same geographical area.

Numerator: Number of new outpatient visits to health facilities for ambulant care in a specified

period.

Denominator: Total health facility catchment population in a specified period.


__________________

Denominator

Data Sources: Health service statistics: HMIS Frequency of

Analysis,

Interpretation

and Response:




annually.

Disaggregation: By sex, age group, location (urban/rural, districts, regions) and socio-economic

characteristics (e.g. education, wealth quintile), level and type of facility.

3 New OPD attendance is the occurrence of a patient attending a clinic for a new episode of illness.

XV | P a g e

2. Hospital (inpatient) admissions per 100 population

Definition: The number of hospital (inpatient) admissions per 100 population.

Numerator: Number of hospital (inpatient) admissions in a specified period.

Denominator: Total catchment population in a specified period.


__________________x 100

Denominator


Analysis,

Interpretation

and Response:




annually.

Disaggregation: By sex, age group, location (urban/rural, districts, regions) and socio-economic

characteristics (e.g. education, wealth quintile), level and type of facility.

3. Bed occupancy rate (Hospitals & HC IVs)

Definition: The number of hospital beds occupied by patients expressed as a percentage of the total beds available in the ward, specialty, hospital, area, or region in a specified period.

Numerator: Number of inpatient days in a specified period

Denominator: Number of available hospital beds in a specified period


__________________x 100

Denominator


Analysis,

Interpretation

and Response:




annually.

Disaggregation: By location (urban/rural, districts, regions), level and type of facility.

4. Health Centre IVs offering CEmOC Services (Functionality)

Definition: The percentage of HC IVs offering CEmOC services.

Numerator: Number of HC IVs offering CEmOC services

Denominator: Total number of HC IVs


__________________x 100

Denominator


Analysis,

Interpretation

and Response:




annually.

Disaggregation: By location (urban/rural, districts, regions) and ownership.

5. Availability of a basket of commodities in the previous quarter (% of facilities that had over

95%)

Definition: The percentage of health facilities with over 95% of the basket of commodities in

the previous quarter.

Numerator: Number of health facilities with over 95% of the basket of commodities in the

previous quarter.

Denominator: Number of health facilities reporting in a given period


__________________ x 100

Denominator

Data Sources: Health service statistics: HMIS

Special facility surveys – Medicines availability study carried out where data on

availability of a specific list of medicines are collected in at least four geographic

or administrative areas in a sample of medicines dispensing points. Frequency of

Analysis,

Interpretation

and Response:




annually.

Disaggregation: By provider type (public/private), health facility level, district, product type. Service quality and safety

6. Client satisfaction index

Definition: The proportion of clients expressing satisfaction with health services.

Numerator: Number of people surveyed expressing satisfaction with health services.

Denominator: Number of clients surveyed


__________________x 100

Denominator

Data Sources: Health Facility Surveys – for facility specific client satisfaction

Population based surveys - for National level determination of client satisfaction

Frequency of

Analysis,

Interpretation

and Response:

Health facility specific data should be collected and analyzed annually.

Data from population based surveys is collected and analyzed every 2 - 3 years.

Disaggregation: By sex, location (rural / urban), type and ownership of facility

7. Average length of stay (Hospitals & HC IVs)

Definition: Average number of days patients spend in hospitals / HC IVs.

Numerator: Total inpatient days of care in a specified period

Denominator: Total admissions in a specified period


__________________x 100

Denominator


Analysis,

Interpretation

and Response:




annually.

XVII | P a g e

Disaggregation: By location (urban/rural, districts, regions), facility level, service provided

(Department) and ownership.

8. Facility based fresh still births (per 1,000 deliveries)

Definition: Number of fresh still births among 1,000 deliveries in health facilities.

Numerator: Number of fresh still births.

Denominator: Number of deliveries in health facilities.


__________________x 1000

Denominator


Analysis,

Interpretation

and Response:




annually.

Disaggregation: By location (urban/rural, districts, regions), facility level and ownership, parity,

and socio-economic characteristics (e.g. education, wealth quintile).

9. Institutional Maternal Mortality

Definition: Number of maternal deaths among 100,000 health facility deliveries.

Numerator: Number of maternal deaths in a specified period.

Denominator: Number of health facility deliveries in a specified period.


__________________x 100,000

Denominator


Analysis,

Interpretation

and Response:




annually.

Disaggregation: By location (urban/rural, districts, regions), facility level and ownership, parity


10. Maternal death reviews conducted

Definition: Percentage of maternal deaths occurring in the facility that were audited.

Numerator: Number of maternal deaths reviewed in a specified period.

Denominator: Number of maternal deaths in a specified period.


__________________x 100,000

Denominator


Analysis,

Interpretation

and Response:




annually.

Disaggregation: By location (urban/rural, districts, regions), facility level and ownership.

11. Institutional under five mortality

Definition: Under five deaths among 1,000 under 5 admissions.

Numerator: Number of under five deaths in health facilities in a specified period.

Denominator: Number of under five admissions in a specified period.


__________________x 100,000

Denominator


Analysis,

Interpretation

and Response:




annually.

Disaggregation: By age, sex, location (urban/rural, districts, regions), facility level and ownership.

12. ART Retention rate

Definition: Percentage of adults and children with HIV alive and on antiretroviral therapy

(ART) 12, 24, 36 months (etc.) after initiating treatment among patients initiating

antiretroviral therapy during a specified time period.

Numerator: Number of patients (adults and children) with HIV alive and on antiretroviral

therapy (ART) 12, 24, 36 months (etc.) after initiating treatment.

Denominator: Number of patients (adult and children) alive initiated on antiretroviral therapy during a specified time period.


__________________x 100,000

Denominator


Analysis,

Interpretation

and Response:




annually.

Disaggregation: By age, sex, location (urban/rural, districts, regions), facility level and ownership,


13. TB Treatment Success Rate

Definition: Percentage of TB cases successfully treated (cured plus treatment completed)

among all new TB cases notified to the national health authorities during a

specified period.

Numerator: Number of TB cases successfully treated (cured plus treatment completed).

Denominator: Number of new TB cases notified to the national health authorities during a specified period.


__________________x 100

Denominator


Analysis,



XIX | P a g e

Interpretation

and Response:


annually.

Disaggregation: Age, sex, treatment history: new and relapse/previously treated (excl. relapse),

HIV, Bacteriology, facility level and ownership.

Health Financing

1. Current expenditure on health by general government General Government allocation for

health as % of total government budget

Definition: General Government allocation for health as a % of the total government

budget.

Numerator: Government of Uganda allocation for health.

Denominator: Total government budget.


__________________x 100

Denominator

Data Sources: Administrative reporting system - General Government Accounts, Public

Expenditure Reviews, Institutional reports of public entities involved in health care

provision or financing, notably MoFPED reports (social security and other health

insurance compulsory agencies when established). GGA reported by the Central

Bank and the MoFPED.

National Health Accounts – resources are tracked for all public entities acting

sources, financing agents (managing health funds and purchasing or paying for

health goods and services) and providers.

Frequency of

Analysis,

Interpretation

and Response:

Analysis, interpretation and response should be done quarterly and annually.

Disaggregation: By organizational, district and health facility level.

Workforce

1. Absenteeism rate

Definition: Percentage of health workers absent from duty at a given time.

Numerator: Number of health workers absent from duty at a given time.

Denominator: The total number of health workers employed at the given time.


__________________ x 100

Denominator

Data Sources: Administrative records – attendance registers, duty rosters

Health service surveys - population based and facility sample surveys e.g.

National Panel Survey, Service Provision Assessment (SPA) or Service Availability

Readiness Assessment (SARA)

Frequency of

Analysis,

Interpretation

and Response:

At facility level administrative records should be analyzed and reported quarterly

and annually.

Periodically validated and adjusted against data from health service surveys.

Disaggregation: By reason (e.g. off duty, study leave, workshops, family circumstances, dual

employment, etc), cadre, sex, type of facility, location (urban/rural) district,

regions).

2. Approved posts in public facilities filled with qualified personnel

Definition: Percentage of approved posts4 filled by trained health workers.

Numerator: Number of approved posts filled by trained health workers.

Denominator: Total number of approved posts for trained health workers in the Public and

Private Not-for-Profit Health Facilities.


__________________x 100

Denominator

Data Sources: Human Resource Information System

Frequency of

Analysis,

Interpretation

and Response:

At district level analysis should be carried out at least twice a year.

At national level reported at least annually, and periodically validated and

adjusted against data from a population census or other nationally representative

source.

Disaggregation: By cadre, sex, age, facility type and ownership, location (urban / rural), district,

region.

3. Health worker density

Definition: Number of health workers per 1,000 population.

Numerator: Number of health workers (per cadre) in a specified period.

Denominator: Catchment population in a specified period.


__________________x 1,000

Denominator

Data Sources: Human Resource Information System

Frequency of

Analysis,

Interpretation

and Response:

At district level analysis should be carried out at least twice a year.

At national level reported at least annually, and periodically validated and

adjusted against data from a population census or other nationally representative

source.

Disaggregation: By Cadre: core professionals (physicians, midwives, nurses); specific cadres such

as specialists (surgeons, psychiatrists, etc); other cadres (dentists, pharmacists)

Distribution: Place of employment (urban/rural); Sub-national (district, region).

Infrastructure

1. Population living within 5km of a health facility

Definition: Percentage of population living within 5km of a health facility (total number of

health facilities per 10,000 population).

Numerator: Population living within 5km of a health facility.

Denominator: Total population in a specified period.


4 Approved posts are the numbers (staffing levels) and types (cadres) of employees established for

the organization.

XXI | P a g e

__________________x 1,000

Denominator

Data Sources: Human Facility Inventory

Frequency of

Analysis,

Interpretation

and Response:

Annually

Disaggregation: By location - (urban/rural); district, region.

Health Information

1. Timeliness of reporting (HMIS 105)

Definition: Percentage of health facilities that submit reports within the required deadline.

Numerator: Number of health facilities that submit reports within the required deadline.

Denominator: Total number of health facilities registered.


__________________x 100

Denominator

Data Sources: Health Service Statistics – HMIS

Frequency of

Analysis,

Interpretation

and Response:

The frequency of data collection should be monthly within the schedule of the

HMIS.


annually.

Disaggregation: By facility type and ownership, location (urban / rural), district, region.

8.5 Indicator Definitions for the Additional Indicators in the DLT

1. Patients diagnosed with malaria that are laboratory confirmed

Definition: Percentage of patients diagnosed with malaria that are laboratory confirmed

(rapid diagnostic test or microscopy) in a specified period.

Numerator: Number of patients diagnosed with malaria that are laboratory confirmed in a

specified period.

Denominator: Number of patients diagnosed with malaria in a specified period.


____________x 100

Denominator


Analysis,

Interpretation

and Response




annually.

Disaggregation Age, sex, facility level and ownership.

2. PCV3 Coverage

Definition: The percentage of under one-year olds who have received three valid

doses of PCV vaccine in a specified period.

Numerator: Number of under one year old who have received the 3rdvalid dose of PCV vaccine

in a specified period.

Denominator: Number of children under one year in the target population in a specified period.


__________________x 100

Denominator



Frequency of

Analysis,

Interpretation

and Response




annually.

Disaggregation By sex, location (urban/rural, districts, regions) and socio-economic characteristics


3. Timeliness of quarterly district financial reporting (OBT)

XXIII | P a g e

Definition: Percentage of districts that submit quarterly district financial reports within the

required deadline.

Numerator: Number of districts that submit quarterly district financial reports within the

required deadline.

Denominator: Total number of districts


__________________x 100

Denominator

Data Sources: Financial Reports

Frequency of

Analysis,

Interpretation

and Response

The frequency of data collection should be monthly within the schedule of the

HMIS.


annually.

Disaggregation By district and region.

4. Average district quality of care score

Definition: Percentage average district quality of care score

Numerator: Total district quality of care scores

Denominator: Number of health facilities assessed in the district


____________x 100

Denominator

Data Sources: Health Service Statistics – HFQAP database

Frequency of

Analysis,

Interpretation

and Response

The frequency of data collection should be annually within the schedule of the

program.

Analysis, interpretation and response should be done annually.

Disaggregation By status – new or old district, number of health facilities per district, functionality

of the DHT.

8.6 CYP Conversion Factors

Method CYP Per Unit

Oral Contraceptives 15 cycles per CYP

Condoms (male and female) 120 units per CYP

Monthly Vaginal Ring/Patch 15 units per CYP

Vaginal Foaming Tablets 120 units per CYP

DepoProvera Injectable 4 doses (ml) per CYP

Noristerat Injectable 6 doses per CYP

Cyclofem Monthly Injectable 13 doses per CYP

Copper-T 380-A IUD 4.6 CYP per IUD inserted (3.3 for 5 year IUD,

e.g. LNG-IUS)

3 Year Implant (e.g. Implanon) 2.5 CYP per implant

4 Year Implant (e.g. Sino-Implant) 3.2 CYP per implant

5 Year Implant (e.g. Jadelle) 3.8 CYP per implant

Emergency Contraceptive Pills 20 doses per CYP

Standard Days Method 1.5 CYP per trained adopter

Lactational Amenorrhea Method (LAM) 4 active users per CYP (or .25 CYP per user)

Sterilization (male and female) Africa 9.3 CYP

Documents

Monitoring and Evaluation Plan for Implementation of the