A new study on 21 health facilities in eight districts has revealed minimal transparency and accountability among hospital boards and health unit management committees (HUMCs).
The Uganda Network of Aids Services Organizations (Unaso) report is titled, ‘Assessment of the functionality of hospital boards and health unit management committees in 21 health facilities in eight districts in Uganda.’ The study, done to assess the extent to which HUMCs and hospital boards perform their functions in ensuring effective and quality delivery of health services, was done in Gulu, Moroto, Sheema, Rakai, Wakiso, Mbale, Mbarara and Mayuge districts.
It cites the inability of some committees to file regular reports to respective stakeholders as the major reason for this trend. Equally perturbing is the fact that some administrative areas are not represented on the committee. Also, some boards and committees are oblivious of their roles to approve annual health unit plans and assess work plans to guarantee that community needs are appropriately addressed.
For example, the HUMC members of Bulondo health centre IV in Wakiso district observed: “We do not participate in the development of annual budgets of the health facility. It is difficult to monitor a work plan when you did not participate in its development.”
The district health officer (DHO) of Sheema laments the lack of transparency, using an example of Kibanga health centre where the in-charge had used Shs 300,000 on an unintended purpose.
“I asked her to allocate some money to meals for visitors and she told me that she had already spent it,” the report partly quotes. “The chairman of the management committee was not aware of the money that the health facility had received. I had to pull out a copy of the guidelines of the roles of HUMC and the in-charge had to surrender Shs 100,000 of the Shs 300,000 she had received. This illustrates how none of the HUMC members knew their mandate.”
Such ineffective governance compromises the ability of management to succeed. For example, most HUMCs had at least two or three members that had dropped out at the time of assessment. The findings also reveal minimal participation of hospital boards in sensitizing the community on health rights, their roles and responsibilities.
Within the framework of the decentralization policy, which Uganda has implemented since 1997, district local government councils are responsible for identifying health priorities and implementing health projects in their districts.
HUMCs and hospital boards oversee the utilization of resources at the health facilities. They also streamline performance of health personnel including ensuring that health workers at health facilities report for work on time, attend to patients promptly and respect the rights of patients as enshrined in the 2009 Patients’ Charter.
Measures recommended by the principal researcher, Dr Narathius Asingwire, to make HUMCs more responsive include a more participatory procedure that involves users in the election of members of the management committees.
“The health ministry should also conduct periodic appreciative assessments or inquiries on HUMC and hospital boards to increase their effectiveness and efficiency in management of health facilities,” Dr Asingwire noted.
He added that there is need to draw elaborate plans and locally mobilize resources to promote community interface activities to increase transparency and accountability. Also, to increase primary health care financing and encourage civil society support, mainly technical support.
Other report findings
1. Where LC-I chairpersons are members of the committee, they have voting rights, instead of being ex-officio members
2. Whereas the policy guidelines provide for membership on the committee for not more than two terms of three years each, some members had served on the committee for more than six years, with some having been on the committee since 2006.
3. Two staff representatives on the HUMC is the norm, rather than one as provided in the policy guidelines
Source : The Observer