Health sector performance: Best worst hospitals, districts named

The government has named the best and worst performing hospitals and districts in the Financial Year 2018/2019, with Mbale Hospital and Serere District- all in eastern Uganda, topping the table.

The worst performing district, according to the Ministry of Health 25th Health Sector Joint Review report released yesterday, is Nabilatuk in the Karamoja Sub-region.

Moroto Regional Referral Hospital in north-eastern Uganda is listed as the worst performing in the same financial year. This was followed by St Francis Nsambya, Kabale, Lira, Rubaga and Mubende hospitals

To determine the best performing hospital, Health ministry officials assessed efficiency parameters using bed occupancy rate (BOR) and Average Length of Stay (ALoS) [in hospital]. The ALoS reduced to an average of four days in FY 2018/2019 from five days in 2017/2018.
The best and worst districts were determined using the District League Table (DLT) composed of input, process, output and outcome indicators such as staffing levels, Tuberculosis (TB) case detection rate, deliveries in health facilities, immunisation coverage, and latrine coverage, among others.

The Annual Health Sector Performance Report evaluates progress of the health sector against the annual work plans as well as the overall health sector performance against the annual targets and performance indicators.
It is a review of what has been achieved, what has not been achieved and provides reasons why the set targets have not been achieved.

“Mbale Hospital continues to produce significantly higher standard unit of output (SUOs) than other Regional Referral Hospitals (RRHs) with an increase to SUO 1,032,453 in FY 2018/2019 from 950,909 mainly owing to the much higher number of admissions (54,845) compared to other RRHs,” the report reads in part.
The SUO is a composite measure of outputs that allows for a fair comparison of volumes of output of hospitals that have varying capacities in providing the different types of patient care services.

In the new ranking of the best performing hospitals, Mbale is followed by Mbarara, Masaka, Jinja, St Mary’s Lacor, Arua and Fort Portal, among other regional referral hospitals. Masaka RRH and Mengo Hospital still have the highest number of total outpatient department attendances at 265,142 and 252,465 attendances, respectively, according to the report.
Mbale was also named best among the regional referral hospitals followed by Masaka and Mbarara in the 2017/2018 Financial Year report.

General Hospitals
Iganga hospital also located in eastern Uganda, emerged the best among general hospitals with the highest standard of unit output of 544,567, followed by Mityana, Tororo General Hospital and Kawolo, among others

“Overall, great improvement was noted mainly in the private hospitals and this is attributed to improved reporting. Gulu Independent hospital was the most improved general hospital followed by UMC Victoria and Lira University Hospital,” the report reads.

The report adds that Gulu, UMC Victoria, Lira and International Hospital Kampala are some of the 20 hospitals that registered the highest change in improvement in FY2018/2019.

Dr Henry Mwebesa, the acting director of general health services, who also presented the report said, the quality of healthcare for the general hospitals was assessed based on some of the maternal health outcomes
“Although the number of caesarean section deliveries decreased from 60,071 in 2017/2018 to 60,038 in 2018/2019, there was a 3.6 per cent increase in the C-section rate,” Dr Mwebesa said while presenting the report at the Prime Mininster’s office yesterday.

Health centre IV
Mukono Town Council ranked number one among health centre (HC) IVs with 263,653 SUO, followed by Yumbe HC IV, Luweero HC IV, Kumi HC IV, Kyangwali HC IV and Kibuku HC IV. Mukono TC HC IV had the highest number of admissions (10,369), deliveries (7,789) and postnatal care attendances (7,694).

Districts
The top 10 best performing districts in FY 2018/2019 are Serere, Jinja, Bushenyi, Rukungiri, Kibaale, Koboko, Kabarole, Kyegegwa, Zombo and Kibuku.
The lowest performance levels were noted in Yumbe, Sironko, Kassanda, Bulambuli, Kaabong, Mubende, Moroto, Buvuma, Amudat and Nabilatuk.

However, the most improved district between 2017/18 and 2018/19 FY was Serere with 32 per cent positive change in score followed by Luuka with 22 per cent and Abim and Budaka districts with 21 per cent improvement change. “There was no change in DLT score in 8 districts of Mitooma, Amudat, Kabarole, Kisoro, Masindi, Rubanda, Kakumiro and Wakiso,” the report reads.

Dr Mwebesa also noted that compared to last financial year which had only 15 districts with decline in performance, in 2018/19 there were 38 districts. “The decline in performance for many districts is largely attributed to inclusion of the refugee population which was not adjusted in the last financial year and as such resulted in very high service coverage for the refugee hosting districts,” Dr Mwebesa said.

Health minister speaks out
Dr Jane Ruth Aceng, the Health minister, however, challenged performance indicators used to rank hospitals, saying that they should be revised so that the report is focused on “preventive” and not “curative strategy”.

“Even the standard unit of output focuses on the hospital with more patients…[therefore] the more admissions [we get in these hospitals] means the more we have failed. For me I get more excited when I see a hospital admitting less patients. It means that area is doing better,” Dr Aceng said yesterday.
As such, the minister noted that: “In my opinion, the facilities that have scored best are the worst performing because they are the ones recruiting more and admitting more.”

Dr Aceng also pointed out that men are a key challenge in the health sector due to their noncompliance to many of the government programmes including Tuberculosis treatment, family planning, HIV, and antenatal care poor performance, among others. This particular observation was however not part of the report.
“As a sector we need to rethink to get men on board if we are to achieve Universal Health Coverage (UHC). Even those toilets that are not covered, it is the men. The hand washing it is the men…everything. We need a full strategic planning for the men alone,” the minister added.

The three-day 25th Annual Health Sector Joint Review Mission and the 11th National Health Assembly that opened yesterday in Kampala highlights health facility performance rating, healthcare standard outputs and ranks districts performance.

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