Idea Transcript
THE REPUBLIC OF UGANDA IN THE MATTER OF THE CONSTITUTION OF THE REPUBLIC OF UGANDA AND THE LOCAL GOVERNEMNTS ACT CAP 243 AND IN THE MATTER OF A CONDITIONAL GRANT UTILIZATION AGREEMENT FOR FINANCIAL YEAR 2012 – 2013 BETWEEN MINISTRY OF HEALTH AND LOCAL GOVERNMENTS THIS Agreement is made this 10th day of May 2012 between the Ministry of Health (MoH) of P.O. Box 7272 Kampala (hereinafter referred to as the “First Party”) of the one part and which expression where the context so permits shall include its assignees, representatives and anyone acting under its authority, and the Local Governments represented by Uganda Local Government Negotiation and Advocacy Team (UNAT) of c/o P.O. Box 23120 or P. O. Box 23092 Kampala (hereinafter referred to as the “Second Party ”) of the other part and where the context so permits shall include its assignees, representatives and any one acting under its authority. For purpose of this Agreement, the two shall be jointly referred to as “the Parties”. Preamble: Article 193(3) of the Constitution of the Republic of Uganda and Section 83(3) of the Local Governments Act Cap 243 provide “Conditional grants shall consist of monies given to Local Governments to finance programmes agreed upon between the Government and Local Governments; and shall be expended only for purposes for which it was made in accordance with the conditions agreed upon”. The above provision requires the expenditure of the conditional grants in accordance with the conditions agreed upon and this necessitates for the local Governments to sit together with the Sector Ministries (Government) to agree upon the conditions.
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Pursuant to the above, the Uganda Local Governments Association and Urban Authorities Association of Uganda, acting for and on behalf of the Local Governments, established the Uganda Local Governments Negotiation and Advocacy Team (UNAT) in 2004 with an aim of representing them and negotiating on their behalf, with the Sectors, the conditions for Conditional Grants utilization. The UNAT is constituted by members of Uganda Local Governments Association and Urban Authorities Association of Uganda. The negotiations are organized and chaired by the Local Government Finance Commission, and witnessed by LGFC, Ministry of Local Government, Ministry of Finance, Planning and Economic Development, Ministry of Public Service and National Planning Authority. WHERE AS 1. The Ministry of Health has the statutory responsibility of inspection, supervision, monitoring, regulation, coordination, mentoring, and provision of technical guidance to Local Governments in the implementation of Government programmes; 2. The Local Governments are the implementers of Government programmes within their locality and jurisdiction in accordance with the Constitution of the Republic of Uganda 1995 and the Local Governments Act Cap 243 as amended; 3. Both parties have a common objective of implementing agreed upon conditions for expenditure of the conditional grants; NOW THEREFORE, having deliberated, the parties do hereby agree to work together towards achieving the above common goal and in so doing, the Parties agree to be bound by the terms and conditions as stipulated here below. Agreement: a) The Agreement shall be deemed to have come into effect on the date of commencement of the financial year and shall run for a period of one year from 01st July 2012 to 30 June 2013, subject to mid-term review. b) Modification of the terms and conditions of this agreement shall only be made by written and signed agreement between the Parties hereto. c) None of the parties to this agreement shall be held liable on any of their obligations herein if owing to an occurrence or event beyond their control or reasonable foresight and without negligence on their part, execution of 2
this Agreement has been rendered impossible. In such circumstances, the parties shall mutually agree on the appropriate way forward. d) Failure to implement any of the provisions of this agreement by any of the parties shall be communicated to the affected party by the defaulting party within two (2) months from the date of failure to implement. The notification shall clearly state the reasons for failure and shall be delivered at the duly appointed and known address of the Local Government Finance Commission, with copies to Uganda Local Governments Association (ULGA), Urban Authorities Association of Uganda (UAAU), Ministry of Local Government, Ministry of Finance Planning and Economic Development, and Ministry of Public Services. e) The Parties shall perform the services and carry out their obligations with all due diligence, transparency, efficiency, and economy. f) The Parties shall have a mid term review to discuss the progress in implementation; highlight challenges faced and make recommendations to improve the process. Purpose The purpose of this agreement is to define and set out the terms and the conditions for the expenditure of the conditional grants for the financial year 2012/2013 in the Health Sector.
Obligations of the Health Sector a) The Ministry shall prepare and disseminate the sector guidelines which will become effective at the commencement of the year for which the negotiation is targeting (FY 2012/2013). b) Shall communicate through circulars addressed to the Chief Administrative Officers and Town Clerks, the issues agreed upon in the negotiations for Local Governments to implement in their respective sectors.
Obligations of the Local Governments a) The UNAT through their Constituent organizations (ULGA and UAAU) shall disseminate to their members the Agreements and highlight the obligations of the Local Governments. b) Implement their programmes based on the guidelines issued by the MoH. c) Timely response to issues raised by the Sector Ministry. 3
Mid-term Review (October 2012) There shall be a Joint Technical Committee (JTC) comprising of six (6) members drawn in the following ratio 1. 2. 3. 4. 5.
Local Governments Finance Commission: 1 Uganda Local Governments Association: 1 Urban Authorities Association of Uganda :1 Sector Ministries: 1 from each sector Office of the Prime Minister: 1
(2) It is agreed that the following shall be ex-officio members to the Committee for purposes of providing technical guidance. 6. 7. 8. 9.
Ministry of Finance, Planning & Economic Development: 1 Ministry of Local Government: 1 Ministry of Public Service: 1 National Planning Authority: 1
(3) It is further agreed that Local Government Finance Commission shall be the Chair of the JTC (4) It is agreed that the following shall be the Terms of Reference (TORs) for the Joint Technical Committee. Oversee implementation of the agreements and monitor the progress of either party. Ensure that the Agreements are disseminated to all stakeholders. Conduct a mid term review of the implementation process so as to obtain feed back and disseminate it to the parties. Identify the non complying parties and make recommendations to the ministry of finance, and office of the prime minister for appropriate sanction Handle any other upcoming issues. The Joint Technical Committee shall report to the respective Policy Organs of their Institutions Any other activity that may be agreed upon by the parties.
Obligations of the Parties
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The planning and budgeting in the Health Sector will be guided by the National Development Plan (NDP) framework, The National Health Policy II (NHP II) and the Health Sector Strategic Investment Plan 2010/11-2014/15(HSSIP). (1)
Operationalisation of Health Infrastructure
Noted that: The meeting noted that Ministry of Health issued a circular to local governments on operationalization of health infrastructure. There are health infrastructures in place which are not operational due to lack staff, equipment and other required medical inputs. Operationalisation of health facilities requires a collaborative effort among many stakeholders including the MoPS, MoFPED, LGs etc. Major limitation of the operationalisation of the infrastructure has been the issue of funding. The MoH has objectives to ensure that the entire health infrastructure in place is operationalised. However, there are challenges of recruitment and retention of staff. MoH Guidelines have been developed but yet to be circulated to local governments. Priority areas for FY 2012/13 are: human resources in the aspect of salary increment, replacement of staff who has left service. Disease prevention especially HIV/AIDS, TB, Malaria and NCDs Epidemics Reduction of maternal mortality Domestic arrears MoH informed the meeting that it has planned to provide equipment to the health units in a phased manner and that it is committed to ensuring that all the health units are functional. Agreed that: i.
The MoH should issue guidelines on operationalisation of the health units to all LGs.
ii.
Establishment of new health facilities/units should only be undertaken based on an assessment of the need on the ground, availability of resources for wage and other operational costs.
iii.
The PHC development grant should be used for constructing staff houses, procurement of equipments, referral transport, and for renovations. The Ministry of Health will issue a circular to local governments immediately on operationalizing of health infrastructure.
iv.
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Standard for Mortuaries: With regard to the Standards for Mortuaries, Local Governments reported that the MoH has not yet circulated the standards as agreed. MoH informed the meeting that the standards for Mortuaries are available and committed to circulate them to Local Governments. Agreed that: MoH to circulate the Standards for Mortuaries by end of June 2012 (2)
Medicines
With regard to the delivery of drugs in time, it was noted that currently the situation is better in terms of timely delivery of the drugs. However, there is a problem when it comes to the equipment as well as the contents in the kits, and quality of packaging. Sometimes the kits contain drugs which are not needed at a particular health centre. Secondly majority of the Mothers deliver at the Health Centre II’s but the supplies for the health centre II’s are usually not made. Agreed: i.
NMS should improve on its packaging of the drugs.
ii.
The content of the drugs delivered to the health units should be reviewed at least every six months.
iii.
If the Kit contains drugs which are not needed in the respective health unit, the District Health Officer should be immediately informed such that the drugs are taken to where they are needed.
iv.
MoH should ensure that NMS is represented on the Negotiation Team during the next sector negotiations of 2013/2014.
(3)
Health Training Policy The MoPS informed the meeting that there is a training policy in place for the entire public service. The sectors should therefore develop training plans which are in harmony with the policy. MoH informed the meeting that a draft health training policy has been developed but adequate stakeholder’s consultations have not yet been done by the MoH.
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The health sector training areas are very broad and diverse for all cadres of staff. The Training Policy broadly highlights the training areas for the various cadres. Agreed: i.
MoH should ensure that adequate stakeholder’s consultations are done and ULGA and UAAU should be brought on board.
ii.
The Ministry will share with the LGs the staffing norms that are required to run the district health services.
(5)
Blood Banks
MoH informed the meeting that Blood banks are under construction in a phased manner, at regional referral hospitals. Agreed: That the MoH shall continue to construct regional blood banks in all the regional referral hospitals (6) Inadequate Staffing LGs lack critical positions in most health centres countrywide. This is attributed to a number of issues, specifically the insufficiency in the PHC wage grant that cannot support 100% staffing in the Health Sector. In addition, there is no provision for increment in the wage. The wage bill for the minimum required staff is less than the PHC wage bill currently provided. With regard to the UNAT recommendation that the PHC wage should be increased to allow for recruitment up to 100 percent of the approved minimum staff structures, MoH said that this is a matter for the Ministry of Public Service. On the issue of MoH contracting and deploying graduate medical workers and other key critical staff for their internship to higher level health facilities immediately after completion, MOH, reported that a total of 133 health workers were deployed including doctors, degree nurses, dental surgeons, and pharmacists. However, after deployment, only 68 of the 133 reported to their work station 30 doctors, 13 degree nurses, 1 dental surgeon and 24 pharmacists. Of the 7
68 those who accepted to work in the Health Centre IV were 6 doctors and one degree nurse. The others were redeployed to the general hospitals. MoH has made budgetary provisions for the next FY to deploy the incoming interns. Local governments argue that the failure to attract and retain health workers is due to unfavorable conditions like lack of staff housing and other social amenities, as well as inadequate salaries. Local Governments are recommending that: health worker’s salaries should be increased and staff house and other social amenities provided. MoPS, concurs with the above concerns and notes that the Ministry has taken some measures like enhancing salaries, there is a hard to reach framework which has embedded some of the Local Governments proposals, but its being implemented in a phased manner. Only the hardship allowance has been implemented and not yet across the country. For designated hard to reach areas, the Framework incorporates a 30% payment over and above basic salaries. MoPS is currently conducting an impact assessment to establish impact so far, where the above hardship allowance has been paid. There is intent to establish a Salary Review Commission. Agreed: i.
The MoPS in consultation with the MoH should review the design of the Hard to Reach framework to allow for payment of Hard to Reach allowance to all medical workers in all Hard to Reach areas.
ii.
MoH in collaboration with Local Governments should carry out a validation exercise of all medical workers to ascertain the number of ‘actual’ and ‘qualified’ medical workers. The exercise should include verification and certification of academic documents.
MoH and working closely with MoPS undertakes regular reconciliation and validation to ascertain whether the health workers as per the MoH records are the ones on the payroll. (7)
Study leave for Medical Personnel:
MoH informed the meeting that the health workers on internship program are now being catered for under Ministry of Heath Budget. Agreed: i.
The Local Governments should develop training plans and evaluate who qualifies for leave on a case by case basis and the study leave should be 8
granted in a phased manner to ensure continuity of service delivery in the Health Centres. ii.
MoH shall adhere to the training policy guidelines of the Health sector when granting bursaries and study leave to medical workers.
iii.
The Health Sector Training Policy should provide clear guidelines on how local government medical officers who go for further studies and are sometimes attached to central government hospitals like Mulago should be dealt with, to enable Local Governments recruit and fill the vacant posts.
(8)
Late Release of Funds:
The sector continues to face challenges related to late release of funds, which affects timely implementation of planned programs. Local Governments contend that the money usually comes a month later after commencement of the Quarter. For example in the FY 2011/2012 the money for the fourth quarter was released during the first second week of May 2012.
Agreed: i.
Local Governments should ensure timely submission of Work plans and budgets.
ii.
Local Governments should expedite the transfer of funds from the General Fund Accounts to the Departmental Operational Accounts.
iii.
MoFPED should ensure timely release of funds
(9)
Pharmaceuticals:
LGs prepare detailed medicines and health supplies procurement plans based on the NMS Guidelines and submit a copy to MOH. Quarterly/bi monthly orders are informed by monthly physical stock counts. However, the NMS supplies items not on the orders of the Local Government for example if drugs are requested; it instead supplies cotton wool in large quantities. Agreed: i.
NMS needs to review the contents of the kit supplied to Health Centres II’s and III’s, because many times critical drugs are not provided either fully/ or are provided in insufficient amounts.
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ii.
NMS should ensure that it supplies to the LGs the contents that are on the orders of the Health Centre IVs and Hospitals.
iii.
The MoH should review the procurement of medicines and health supplies with a view to ensure highest quality and lowest price.
iv.
NMS should increase the supply of ARV drugs to Health Centers especially for care of all infected persons especially pregnant women and children
(11)
Epidemic preparedness:
Noted: That MoH has been doing this. MoH will continue to support LGs on epidemic preparedness and response Agreed: MoH will continue to respond promptly on the reported emerging diseases and epidemics.
(12)
Reporting and Quality assurance:
Noted: The HMIS is the official reporting system for health data within the health sector and should be emphasized to help eradicate/reduce on parallel systems that are hindering quality performance of the HMIS. The HMIS’ newly revised tool has included a community module which is going to be used to capture data right from the community level by use of VHTs. Agreed: i.
MoH should harmonize all parallel systems of HIMS reporting by the LGs to avoid duplication.
ii.
LGs should put in place mechanisms for inter sectoral collaboration for health improvement especially with Agriculture, Water, Education and Roads.
(13)
Immunization;
Noted that: 10
The trend of immunization coverage is declining. Agreed i. MoH should provide resources to address the declining trends in immunisation coverage. LGs should be supported by MoH to strengthen routine immunization so that DPT3/OPV3 is done and also introduce Pneumococcal Vaccine into routine immunization. ii.
MoH should ensure that all health facilities have gas run fridges for the storage of vaccines at all times.
iii.
MoH should ensure that all LGs have access to immunization by reopening outreaches
(14)
National Disease control for Non Communicable Diseases:
Noted: There is a rapidly increasing incidence of Non Communicable Diseases (NCDs) and low level of public awareness about NCDs. The MoH is developing standards for NCD prevention and treatment.
Agreed i.
MoH should consult with LGs in the development of this NCD policy and ensure that the outcomes are widely disseminated to the LGs and other key stakeholders.
ii.
The MOH should ensure that NCDs activities are well articulated in the LGs’ annual work plans to enable the MOH support their implementation.
iii.
MoH should continue in the efforts to attain 100% universal coverage with long-lasting insecticide treated nets by the end of 2012. MoH should plan to sustain this thereafter.
(15). Social Health Insurance: As part of Government’s efforts to improve and re-organize health financing and related outcomes. A National Health insurance scheme bill is yet to 11
approved by parliament. In the fiscal year 2012/13, Social Health Insurance activities will concentrate on building capacity of LGs to implement the scheme. The plan is designed to work in harmony with other social security benefits. Agreed LGs should act as advocates for SHI and support the initiative. (16). National Health Accounts: The MoH is in the process of institutionalizing the NHA in the country. This is to further enhance reporting on health expenditures for purposes of evidence based Decision making. Agreed Recommendation: Outcomes of the NHA studies should be shared with all LGs in the first Quarter of FY 2012/2013 (17).
Stock out of Mama Kits:
MoH informed the meeting that this matter has been discussed by NMS but NMS argues that they are not requested for by LGs. MoH commits and agrees with the recommendation Agreed i.
In order to increase proportion of deliveries in health facilities (HC IIs, IIIs, HC IVs, and Hospitals) to at least 44%, MoH has to make a commitment to ensure that Health Centers have 100% stock up of mama kits in FY 2012/2013 and subsequent years.
ii.
NMS should include Mama Kits on their list for regular supplies to Local Governments to be made periodically.
iii.
MoH shall communicate to the LGs, the clear guidelines on the distribution of Mama Kits.
(18)
OTHER MINISTRY OF HEALTH RECOMMENDATIONS
a. New facilities Accessing Drugs LGs should submit the details of the new units to MoH early before the commencement of the Financial Year. 12
b. Supervision of Health Units Supervision/inspection of health services is not being effectively done at the LG level The CAOs should spearhead the supervision of the health service delivery in the districts c. Reporting Local Governments should endeavor to submit timely quarterly reports based on the health sector key performance indicators. d. New Districts Money for some new districts sometimes passes through the new districts LG leaders should ensure that money channeled through the old districts should be remitted to the new districts as soon as possible. e. NGO Health Facility Operations All PNFP’s that are getting grants from Government are supposed to sign Memorandums of Understanding with the Local Government annually for purposes of monitoring and supervision.
IN WITNESS WHEREOF the appointed representatives of Parties hereto have set their hands on this agreement on the day, month and year first above written. Signed for and On Behalf of Local Governments:
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In witness hereof: (Authorized Representative)
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