MBARARA UNIVERSITY OF SCIENCE

&TECHNOLOGY

SUCCEED WE MUST

FACULTY OF APPLIED SCIENCES AND TECHNOLOGY

DEPARTMENT OF BIOMEDICAL SCIENCES AND ENGINEERING
BACHELOR OF BIOMEDICAL SCIENCES AND ENGINEERING
COURSE CODE: BME 4202
COURSE UNIT: HOSPITAL MANAGEMENT
Name; MULONGO LINO

Reg. No. 2016/BME/008/PS

LECTURER: DR.ENG OBUGOLOCH JONES (PHD)

question
Explain the organization of Uganda Healthcare system. Indicate:
 The Human Resource structure at ministry of health
 Classification of hospitals + services they provide

 Number of hospitals in each category

 Leadership the HR structure

 Populations they serve

 Services they provide

 Sources of financing (Central/Local Government, user fees, donor funds, etc)

 List of Accronyms
DHT District Health Team
DHMT District Health Management Team
GOU Government of Uganda
HC Health Center
HPAC Health Policy Advisory Committee
HRH Human Resource for Health
HSDP Health Sector Development Plan
HSSIP Health Sector Strategic and Investment Plan
HUMC Health Unit Management Committee
M&E Monitoring and Evaluation
MOH Ministry of Health
NCRI National Chemotherapeutic Research Institute
NDA National Drug Authority
NMS National Medical Stores
PHC Primary Health Care
PNFP Private-Not-For Profit
RRH Regional Referral Hospital
TCMP Traditional and Complementary Medical Practitioners
TWG Technical Working Group
UBTS Uganda Blood Transfusion Services
UDHS Demographic Health Survey
UNHRO Uganda National Health Research Organization
UVRI Uganda Virus Research Institute
VHT Village Health Team
1.The Uganda health care system
The Uganda’s health system, like other systems, aims to achieve and sustain good health for its
people. The Health system has been evolving over the last 3 to 4 decades to handle emerging
concerns and challenges to the health situation in the country. Health Care Delivery has mostly
been through modern and Traditional practices [1].

The Uganda health system is organized on the basis of the ownership/founders of financers as
follows;

 Public Sector

These are owned by the central government. These are funded by the central government in
partnership with private not for profit organisations. Health care system is decentralized where
the district health structure is responsible for all structures in district except the regional referral
hospitals where the exist. In recent developments, the abolition of user fee has characterized
these hospitals.

 Private Not for Profit (Faith Based)

These are funded by the charity organizations or churches. Usually offer free medical services or
cheap/affordable medical services to the community. These hospitals/health centers aim at
providing health care to the poor people or even communities where they operate.

 Private Medical Practice

These are funded by the patients whom they serve (user fee). They totally depend on the fees
they obtain from the users. They are usually expensive and patients pay for all the costs involved
in their treatment as well as the practitioner’s fee.

 Traditional and Complementary Herbal medicine

These play a vital role in offering health services to the community. they are funded by the
patients’ user fee. They are also essential in the maintenance or preservation of culture and
customs.

o Traditional Birth Attendants

o Bone Setters
o Spiritual Healers

o Community health workers/promoters/drug peddlers

A chart summarizing the health care system of Uganda

HUMAN RESOURCE STRUCTURE AT MINISTRY OF HEALTH

Figure 1 Leadership structure for ministry of health source HSDP2015-2020 [2]

The ministry of health of Uganda operates based on committees which comprise of different members
therefore the leadership structure at ministry of health will be explained based on different committees at
deafferent levels of leadership [3].

Cabinet / Parliament

The parliament/cabinet oversees the ministry of health to implement and support their policies and
decisions that are made. It also ensures that the development plans of the health sector progress and are
adhered to by the general public. In other wards it oversees the activities of the MOH.

Senior Top Management Committee (STMC)

The STMC forms the top most decision making organ for governance in the MOH.it spearheads inter-
ministerial collaboration, endorse policies, mobilise resources And it is Composition of Minister of
Health(Chairperson), Permanent Secretary(Secretary) and other Members Minister of Health (General
Duties), Minister of Health (Primary Health care), Director General Health Services (DGHS), Director
Health Services - Planning and Development (DHS P&D), Director Health Services - Clinical and
Community (DHS C&C)

Top Management Committee (TMC)

This is the second top most decision making committee at the MOH. They provide oversight
function for all projects, programs and other activities in the ministry, receive and discuss
policies at the health sector, ensure proper accountability and effective communication It is
chaired by the minister of health and the permanent secretary the secretary. And has other
members such as Minister of Health (General Duties),Minister of Health (Primary Health care),
Director General Health Services, Director Health Services Planning & Development, Director
Health Services Clinical & Community Health Services, Commissioners of Health Services
(Clinical, National Disease Control, Quality Assurance, Planning, Community Health and
Nursing), Executive Director – Uganda Virus Research Institute, Executive Director – Uganda
Blood Transfusion Services, Executive Director – Uganda National Health Research
Organisation, Executive Director – National Drug Authority, Executive Director – National
Chemotherapeutics Research Institute, Executive Director – Mulago National Referral Hospital,
General Manager – National Medical Stores
Health Policy Advisory Committee (HPAC)
The Health Policy Advisory Committee was established as a forum for the Government, Health
Development Partners (HDPs) and other stakeholders to discuss health policy and to advise on
the implementation of the HSSIP and policies. HPAC is a donor / stakeholder coordination
mechanism which supports the functions of the Top Management in policy related issues.
It is chaired by the Permanent Secretary and Co-Chaired by the Head of Development Partners,
and the Secretary is the Commissioner Health Services Planning. The Members are Director
General Health Services, Director Health Services Planning & Development, Director Health
Services Clinical & Community Health Services, .Under Secretary – MOH, Executive Director
Mulago National Referral Hospital, Executive Director Butabika National Referral Hospital,
Secretary of the Health Services Commission, Commissioners of Health Services: Clinical,
National Disease Control, Quality Assurance, Planning, Community Health and
Nursing ,Assistant Commissioner Accounts, Representatives of the HDPs, Representatives of
Bilateral Agencies, Board Chairperson National Medical Stores (NMS), Representative of: -
Medical Bureaus -Hospital Directors for the Regional Referral Hospitals -District Health
Officers -Civil Society Organizations (CSOs), Other members shall be co-opted as need arises to
address specific issues during HPAC proceedings .
Senior Management Committee (SMC)
This is a decision-making organ and constitutes senior members of the MOH. it reviews and
discusses the MOH work plan, budget, reports, and other project activities. SMC reports to
HPAC. It is Chaired by the Director General Health Services and the Secretary is the
Commissioner Health Services Quality Assurance Department its Members include the Director
Health Services Planning & Development, Director Health Services Clinical & Community
Health Services, Under Secretary, All Commissioners, All Assistant Commissioners, All
Program Managers, All heads of Units (Principal or Senior Level) , All Principal Level Officers,
Technical Advisors, Registrars of the Professional Councils SMC can co-opt members as need
arises to address specific issues that may occur.
Technical Working Groups (TWGS)
These report to the SMC. They handle all the technical issues each focusing on their technical
area. They handle the medicine procurement, health infrastructure, disease control, e-health and
all the technical areas of the ministry. Furthermore, HPAC and MOH Top Management may task
TWGs with specific issues to resolve. It is divided into four main areas that is; Nutrition which
was previously a component under the MCH subcommittee has also been established as a TWG
to address the diverse nutrition interventions. The e-Health, and Policy, Legal and Regulatory
TWG have also been established to address the new innovations in Information Communication
and Technology and strengthen policy development and analysis in the health sector.

Regional Management Committee

The purpose of the Regional Management Committee is to provide technical guidance,

coordination, supervision and monitoring of health service delivery at regional level.

District Health Management Team (DHMT)

The purpose of the DHMT is for effective co-ordination between all health related players in the
district. It is responsible for planning, organizing, M&E of services in the whole district using
available information.

HSD Management Team

Like the DHMT, the HSD Management's purpose is effective co-ordination between all health-
related players in the HSD. It is responsible for planning, organizing, M&E of services in the
HSD using available information as well as ensuring provisions of quality primary health care
health services, supervise monitor and train lower level health workers e.g. VHT
Health Unit Management Committee (HUMC)

The HUMCs or Hospital Boards are composed of various stakeholders from the health facility,
local administration and community and are responsible for planning, M&E, reporting and
playing an advisory role for quality health service delivery.

Organisation of the public health sector in Uganda

Village health teams/community medicine distributors

The first contact for someone living in a rural area would be a medicine distributor or a member
of a village health team (VHT). Each village is supposed to have these volunteers using bicycles
[1]. They still have no medicine, but they can advise patients and refer them to health centres
hence, they are a link between the community to the health care system. They serve a population
of less than 500 people and they are about 1578 in the country.

Health centre II

According to the Ugandan government's health policy, every parish is supposed to have
one of these centres. A health centre II facility, serving a few thousand people (about 500-
20,000), should be able to treat common diseases like malaria. It also has preventative,
promotive and outpatient curative health services, outreach care and emergency. It is supposed to
be led by an enrolled nurse, working with a midwife. It runs an out-patient clinic, treating
common diseases and offering antenatal care. In Uganda, they are 3364 health center IIs [4].

Health centre III

This facility should be found in every sub-county in Uganda and they are 1569 HC III in
Uganda each serving a population of about 20000 or more people. These centres should have
about 18 staff, led by a senior clinical officer. It provides preventative, promotive, outpatient,
curative, maternity, inpatient health services, emergency surgery and blood transfusion, and It
should also have a functioning laboratory.

Health centre IV/ District Hospital

 This level of health facility serves a county and there are 222 health center IV hospitals in
Uganda. In addition to services found at health centre III, it should have wards for men, women,
and children and should be able to admit patients. It should have a senior medical officer and
another doctor as well as a theatre for carrying out emergency operations. It serves a population
of about 100000 or more.

General Hospitals.

they are 163 general hospitals in Uganda and each hospital serves a population of about
500000 or more people. They offer all services offered by the health center IVs however, it also
offers other general services such as training, consultation, radiology, gynecology, pediatric,
surgery and research to community based. It is managed by a management board consistent of
nine members that include the district health officer, public figure, staff representative, assistant
chief administrative officer in charge of health, head of nursing, three figures not political and
medical superintendent [5]. It has the same leadership structure as the RRH but with less
specialist services.

Regional Referral Hospital (RRH)

There are 10 RRH which should have all the services offered at a general, plus
specialised clinics–such as those for mental health and dentistry–and consultant physicians. Each
of these hospitals serve a population of over 2 million people. The hospital has a management
Board consistent of nine members. At the top of the leadership of the hospital after the
management board is the medical superintendent then the leaders of different departments that is
the administration, nursing, pharmacists, biomedical engineer, allied professionals. The
leadership structure is summarised in the diagram below
 MOH

manageme
nt board

medical
supretenda
nt

senior Allied medica principle

anaesthetic dental biomedical
hospital professiona pharmacist offices sp. nusing
officer surgeon engineer
admin ls grade officer

public
sen senior
hospital personel anesthetic health biomedical
dispenser medical nursing
admin officer assistant dental technicians
officer officer
officer

sen lab
sen acct records stores steno support pharmacy sen clinical health medical nursing
technologis
officer assist assist secretary staff orderly officer educator officer officer
t

lab
clinical enrolled enrolled
accountant technologis
officer midwives nurse
t

nursing
cook
assistant

Figure 2 administrative structure of regional referal hospitals [6]

National Referral and Teaching Hospital

At the top of the healthcare chain is the national referral hospital.it offers all the services as well
as a teaching hospital. There are two national referral hospitals in Uganda. That is Mulago
hospital for all medical conditions and Butabiika hospital for mental illness related cases. This is
where some of the best medical brains can be found, often working part-time at private clinics to
supplement their meagre government salaries. They serve a population of about 31,000,000
people or more.

2. The Biomedical Engineering Department (medical equipment

Maintenance Unit) [7]
There is a wide range of medical equipment at different levels of the health care delivery system.
The staffs in these Health Facilities are responsible for ensuring that it is used and stored
properly and faulty equipment is reported to departments responsible for maintenance.
At the central level, the Unit directly responsible for the management of medical equipment is
the Health Infrastructure Division (HID) under the Clinical Services Department. The National
Advisory Committee on Medical Equipment is mandated to give appropriate clinical and
technical advice to MOH regarding medical equipment.
At District and Health facility levels, the management of medical equipment is the responsibility
of the respective Administrative and Technical Departments. The District Health Officers
(DHOs) are directly responsible for planning and management of medical equipment in the
District Local Governments.
For medical equipment, RWs established under Regional Referral Hospitals (RRHs) carry out
medical equipment maintenance; while the HID of the MoH oversees supervision of
maintenance activities.
National Advisory Committee on Medical Equipment (NACME)

The main function of NACME is to review the country’s medical equipment needs and determine the
appropriate policy framework. This includes advising on procurement, standardization, maintenance and
rehabilitation of medical equipment, bearing in mind cost-effectiveness and appropriateness of
technology.

Health Infrastructure Division (HID)

The division has two major sections with the mandate to formulate policies and guidelines on health
infrastructure development and management. That is Civil Engineering Section and Electro-Mechanical
Engineering Section

Civil Engineering Section

All building and Civil Engineering in the Sector are coordinated by this section. It provides support and
supervision of pre-installation works and ensuring that fixed medical equipment is installed safely.

Electro-Mechanical Engineering Section

This section encompasses the electrical and mechanical engineering disciplines. The electrical and
mechanical engineering professionals are responsible for preparing specifications and ensuring that
procured equipment conforms to national and international standards; and that the equipment is
appropriate and maintainable.

Some of the activities related to medical equipment in this section include:

Supervision and monitoring the management of the complete life cycle of medical equipment and
furniture in public health facilities.

Acting as the Secretariat to NACME and take care of the executive work for the committee. Preparation
of the standard equipment lists and update of specifications is handled by the Electrical/Mechanical
Engineers.

Specification and quantification of equipment for procurement in the health sector.

Organizing training from time to time so as to ensure that technicians and engineers keep abreast with the
fast-changing trends in Biomedical engineering.

Figure 3 organisation structure of the health infrastructure division

Regional Medical Equipment Maintenance Workshops (RWs)

In order to decentralise medical equipment maintenance, the MOH established RWs at RRHs to
maintain medical equipment in health facilities under their catchment area.
To date there are nine (9) RWs located at Arua, Lira, Gulu, Soroti, Mbale, Hoima, Fort Portal,
Kabale RRHs and Central Medical Equipment Maintenance Workshop, Wabigalo in Kampala.
The Central Medical Equipment Maintenance Workshop (CW) was established under HID and is
a referral workshop for all other RWs.
At the National Referral Hospital level, the Engineering and Administration Departments are responsible
for equipment management. The Hospitals have a fully-fledged Engineering Department that works
independent of the RWs.

At RRHs, the management of medical equipment is the responsibility of the Hospital Administrator and
respective RW Manager. While the RWs are part of the Hospitals, they have responsibilities to maintain
medical equipment in all the health facilities in their catchment area. This is one of the outreach services
of the RRHs.

At the District level, the management of medical equipment is the responsibility of the DHO and the
respective in-charges of the Health Facilities. District Engineers in Local Governments assist the DHO to
plan for health infrastructure development and management.

Staffing levels for medical equipment maintenance in Districts is still quite low. There is also a country
wide shortage of Biomedical Engineering human resource in both private and public health institutions.
The RWs support health facilities in the relevant districts to carry out periodical maintenance and repair
of medical equipment.

Function, Operation and Role of RWs

In line with the 1999 policy recommendations of NACME, a maintenance structure consisting of the CW
and RWs was established in Uganda to cater for medical equipment maintenance in Health facilities
countrywide.

A RW is established as one of the support services sections under the RRH. In terms of set up, it consists
of; Workshop building with office space, stores and work area, Mobile workshop vehicle, Tools, Test
Equipment and Office Furniture

Operationally, the teams of technicians from the RW visit Hospitals, DHO’s stores and HCIV to carry out
equipment maintenance on site. For HCII and HCIII, the faulty medical equipment is delivered to the
DHO’s stores or HCIV by the In-charge of the HC for the workshop team to carry out maintenance. On a
case by case basis, the RW team may visit a HCII or HCIII to repair immovable equipment like a
generator, solar system.

Central Medical Equipment Maintenance Workshop, Wabigalo (CW)

The CW located in Kampala is the RW for Health facilities for the Central region and a referral
workshop. It is also acts as a training centre for Hospital based technicians. Other roles and functions of
the CW include the following:
Supervision of all RWs through the Electro-Mechanical Engineering Section of HID focusing on
maintenance and repair activities, review of work plans and budgets; and quarterly reports.

Identification of suitable service providers and guidance on procurement of spare parts.

Plan for capacity development activities for all regional workshops. This involves human resource
development, mentorship.

Support other RWs to carry out and update medical equipment inventory.

Regional Medical Equipment Maintenance Workshops

The RWs are based at the RRH and cater for maintenance of medical equipment in health facilities within
the catchment area. While day to day supervision of the operations of RWs is under the Administration of
the RRH, each workshop has a RW Management Committee that over sees its operations. The RW
Management Committee consists of members from all beneficiary hospitals and the District and Health
Sub-District Authorities.

The main functions of RWs include the following:

Maintenance of medical equipment in all health facilities in their catchment area.

Medical equipment inventory update in all health facilities in their region.

Advise hospital managers on medical equipment disposal.

Preparation of quarterly equipment maintenance reports for submission to ACHS(HI)

Organizing and participating in the Regional Workshop Management Committee (RWMC) Meetings.

Organizing User Training for equipment Users in proper use, handling and first line maintenance.
References

[1] J. Kamwesiga, "UGANA HEALTH CARE SYSTEM Comunity and Home Based Rehabilitation Course," KI,
Kampala, 2011.

[2] MOH, Health sector Development plan 2015/16-2019/20, Kampala: GOU, 2015.

[3] MOH, THE SECOND NATIONAL HEALTH POLICY Promoting people's health to enhance Socio
Economic Developement, Kampala: GOU, 2010.

[4] MOH, "NATIONAL HEALTH FACILITY MASTER LIST 2018 A complete list of all health facilities in
Uganda," GOU, Kampala, 2018.

[5] MOH, "Guidelines For General Hospital Management Boards," GOU, Kampala, 2019.

[6] MOH, Administrative Structure Entebbe Regional Referal Hospital, Kampala: GOU, 2019.

[7] MOH, "Operation Manual for Regional Medical Equipment Maintenance Workshops and Medical
Equipment Maintenance Guidelines," MOH, Kampala, 2013.