Uganda has made steady progress during 2015/16-2019/20 on several key indicators of the reproductive, maternal, newborn, child and adolescent health (RMNCAH) continuum of care, but most did not reach the set targets, according to an endline review report published by the Countdown country collaboration in Uganda, in partnership with the Uganda Ministry of Health, and the World Bank.
Progress is too slow to reach the targets set in the Reproductive, Maternal, Newborn, Child and Adolescent Sharpened Plan for Uganda (2016/17-2019/20) and the Global Financing Facility investment case. The main contributor to this slow progress was the delayed and limited implementation of the Sharpened Plan and the investment case, which was occasioned by challenges of managing the “shifts” model in the public sector.
The report highlights the overall implementation, progress attained, lessons learned, and challenges experienced during the implementation of the Investment Case for the Sharpened Plan. It is based on analysis and synthesis of existing data, especially the routine health management information system (HMIS)/DHIS2 data which was used to assess progress on key indicators, focusing on trends from 2015 to 2019. All health-related surveys conducted in 2015 or later were considered – Performance Monitoring for Action (PMA), Malaria Indicators Survey (MIS), and the Uganda Demographic Health Survey (UDHS). The UDHS 2016 helped strengthened the baseline but cannot be used to provide information on the Sharpened Plan’s performance as it does not cover the implementation period. In addition, A desk review was done, and primary data collection among key informant interviews was conducted at the national level and in 15 districts during the period July-August 2020. Data on the health system were obtained from the Ministry of Health, World Bank, and development partners.
The report also makes the following recommendations for the development of the next Sharpened Plan and Investment Case:
1. Develop/finalize and operationalize the following interlinked key policies and strategies:
- adolescent sexual and reproductive health
- urban health
- community health systems
2. Improve partnership’s coordination and alignment, and build implementation and management capacity at all levels: national, regional, urban authorities, and district levels.
3. Strengthen RMNCAH/N financing mechanisms: In line with the spirit of the GFF supported investment case, financing for RMNCAH/N needs to be streamlined as follows:
- Funding from partners should align with the government’s planning and budgeting cycles and priorities.
- Improve the timely availability of granular data on RMNCAH/N expenditure, with a focus on district and hospital-level expenditures.
- Track off-budgeting financing, analysing trends by area, channel and its volatility.
- Conduct rigorous evaluations of major donor-funded projects.
- Regularly assess the impact of the resources allocation formula on horizontal equity and revise it as needed.
- Track domestic resources allocated to RMNCAH.
4. Optimise the delivery of high impact interventions and improve program efficiency in both preventive and clinical services.
5. Develop new M&E framework that includes both the survive and thrive indicators.