Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3312
Country/Region: Uganda
Year: 2009
Main Partner: IntraHealth International, Inc.
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $1,251,252

Funding for Health Systems Strengthening (OHSS): $1,251,252

Activity Narrative: Uganda like many developing countries is experiencing a crisis in human resources. The

human resources are inadequate both in number and skill mix to effectively respond to the health needs in

Uganda. The HIV/AIDS epidemic presents additional demand on the human resources because of special

skills required for HIV/AIDS prevention and treatment, and health workers themselves are being affected by

the disease. The Government of Uganda institutional capacity for Human Resource and Health (HRH)

policy and planning is weak. There is no reliable source of HRH information for planning and management.

This makes planning and monitoring of the human resource situation difficult. There is no capacity to

develop, regularly monitor and review HRH policy and plans either at national or district level. HRH

development, deployment and utilization are therefore not guided. This results into mismatch between

service requirements and training, both in numbers and skills, and inequity in the distribution of the available

human resources.

The working condition of health staff is difficult, characterized by poor infrastructure, lack of staff

accommodation, inadequate equipment and supplies, work overload and inadequate remuneration. The

poor working condition is aggravated by weak HRH management. Performance management, regulatory

and disciplinary mechanisms are ineffective. Poor working conditions do not attract staff nor motivate them

to stay. As a result the staff turnover is high, particularly in remote rural districts generally regarded as

difficult-to-reach and difficult to stay in. As a result of poor working conditions the morale of health workers

is low, which in part results in poor attitude towards clients, absenteeism and low productivity. The public

image of health staff has been eroded, the quality of care provided is perceived as poor and the utilization of

health services is not optimal. There are inadequate resources to sustainably support initiatives to address

these human resources issues and the crisis persists in a vicious circle. Despite increased investment in the

HRH sub-sector and health sector in general, the performance of health workers and the quality of

HIV/AIDS and health services are still substandard. Consequently, the utilization of HIV/AIDS services is

low, contributing to low achievement of the indicator targets. The USAID-funded IntraHealth/Capacity

Project (CP) goal is to improve human resources for health in order to contribute to improved access for

HIV/AIDS and other health services. The objectives of the Capacity Project are to enhance capacity for

HRH policy and planning at the central and district levels to ensure adequate health workforce for integrated

HIV/AIDS and health services; strengthen systems for effective performance-based health workforce

development; and identify and promote health workforce management practices for improved performance

and retention.

Progress to-date and achievements: The CP has made significant progress in HRH policy and Planning and

HRH development and management. The CP supported the Ministry of Health (MoH) to establish the HRH

databases at the four Professional Councils of Medical Doctors and Dental Surgeons, Nurses and

Midwives, Pharmacists: and Allied Professionals, and linked the database to the MoH and the two pilot

districts of Apac and Oyam. The CP supported the MoH to review the HRH Strategic Plan 2005-2020 and

further develop the plan into the comprehensive HRH plan. The CP collaborated with the MoH to develop a

Health Sector Master Plan for 2008 -2015 that prioritized HRH, infrastructure, and medicines and supplies

to attract increased funding for health sector. Nine districts of northern Uganda were facilitated to do

detailed analysis of staffing gaps and prepare district specific strategies to address the staffing gaps; while

78 districts developed district specific HRH Action Plans in line with national HRH Policy and Strategy. A

total of 133 members of the Uganda National Association of Nurses and Midwives (UNANM) were trained

as regional trainers in communication skills; while Health Professional Councils and Associations were

supported to develop standards for accreditation of in-service training and continuing professional

development (CPD). The CP supported the MoH to introduce a Performance Improvement (PI) program,

including training of the Technical Resource Team at the central and district levels, development of

reproductive health and PMTCT standards, and performance indicators and tools for PI. Central level

resource team was trained for strengthening performance management based on ROM and open

performance appraisal system in collaboration with the Ministry of Public Service. The MOH was supported

to study the factors that contribute to high staff turnover in public and private-not-for-profit (PNFP) sectors.

Comprehensive strategies for improved retention and motivation, and policy and guidelines for workplace

safety and health are being developed. Bottlenecks in HRH management and solutions for tackling them

were identified. Strategies are being developed to strengthen leadership and management at district, sub-

district and health facility levels.

Activities for FY 2009: With FY 2009 funding, the Capacity Project, in partnership with the line ministries of

Health, Public Service, Education and Sports, and Local Government will:

1. Enhance the capacity for HRH policy and planning at the central and district levels to mitigate the HRH

impact of HIV/AIDS by:

a. Completing the HRIS development and integration by linking the district and PNFP data base to the

MoH Human Resource Management (HRM) data base; link the pre-service training database at the Ministry

of Education and Sports to the MoH training database; and develop an interface of all HRIS information to

the Resource Centre at the MoH. The CP will establish an HRIS planning module at Human Resource

Development (HRD) and Planning Department of the MOH; support regular production and dissemination of

biannual HRH report for decision making; and implement strategies to improve communication between the

central MOH and districts for HRH management.

b. Strengthen the coordination of HRH by providing technical and logistical support to the coordinating

structures, including the Human Resource Working Group (HRWG), the Health Workforce Advisory Board

(HWAB), and other SWAp process. The CP will strengthen the HRD of the MOH by providing technical

assistance for development of the strategy for task shifting; facilitate the HRD and HRM divisions of MOH to

develop plans for follow up implementation of HRH related recommendations of the Mid-Term Review of the

Health Sector Strategic Plan II (2005/06-2009/20100; continue to support the roll out and reviews of HRH

Strategic Plan; and facilitate follow up support of district HRH planning.

2. Strengthen systems for effective performance-based health workforce development by:

Harmonizing pre-service and in-service training of the health workforce; developing and promoting

approaches for effective performance improvement (on-job training, task shifting, mentoring, supportive

supervision, action learning); developing strategies to motivate continuing professional development

including accreditation, certification, licensure; strengthening the role of the health workforce professionals'

Activity Narrative: councils and associations in in-service training and continuing professional development; and providing

technical assistance to the Human Resource Department of the MOH and Health Manpower Development

Center to rationalize training and develop a training plan for pre-and in-service training.

3. Identify and promote health workforce management practices for improved performance and retention by:

strengthening systems for health workforce performance management; enhancing MOH and district

capacity for health workforce management; building capacity for results oriented management (ROM);

developing strategies and systems for improved recruitment and deployment; developing tools and

initiatives for improved job satisfaction and retention; strengthening systems for Performance Improvement

(PI) and support supervision; enhancing systems for community co-management of health services; and

strengthening systems for workplace safety, and protection and care of the health workforce.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14215

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14215 4376.08 U.S. Agency for IntraHealth 6741 3312.08 The Capacity $1,260,000

International International, Inc Project


8429 4376.07 U.S. Agency for IntraHealth 4837 3312.07 The Capacity $1,260,000

International International, Inc Project


4376 4376.06 U.S. Agency for IntraHealth 3312 3312.06 The Capacity $500,000

International International, Inc Project


Emphasis Areas


* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Family Planning

* Safe Motherhood

Refugees/Internally Displaced Persons

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $1,250,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening



Table 3.3.18:

Subpartners Total: $90,000
Johns Hopkins University: $25,000
Management Sciences for Health: $25,000
Technical Resources Group: $40,000
Cross Cutting Budget Categories and Known Amounts Total: $1,250,000
Human Resources for Health $1,250,000