HCE Program Update: Bulamu’s Scale Up Continues

With the Memorandum of Understanding (MOU) signed with Isingiro District in September, Bulamu now has MOUs and partnerships with 9 local government districts that operate a total of 274 public hospitals and clinics. At the end of September 2021, our health systems strengthening programs were installed in 138 of those facilities, including all the larger ones, with the rollout to the remaining 136 health units coming in the next months. The HCE hospital/clinic management system utilizes weekly and monthly graphic reports to give health unit in-charges and district officials data they have not had before, allowing them to provide stronger management oversight and drive continuous improvement in patient care metrics.

As districts use these reports, they will improve productivity and performance because we now help them to monitor absenteeism by measuring “payroll yield,” which is how many days each week a clinician is on site treating patients, and because we track how many patients each clinician interacts with every week. For example, midwives perform six different clinician activities: 1) Antenatal examinations of pregnant women; 2) Natural and C-section deliveries; 3) In-patient care of mothers and newborns; 4) Post-natal mother and child examinations; 5) Family planning visits with women or couples; and 6) Immunizations of children and adults. Our system assigns a weighting to each activity based on average time required and calculates an overall “patient equivalent” number for each week’s patient interventions. The table below shows a monthly ranking of midwives in one district (names are redacted), making clear who the highest performers are and where coaching or corrective action may be necessary.

With reports like these never available in Uganda’s public health system before – and perhaps in any African country – we are confident the health system’s performance will improve over time by sharing recent Key Performance Indicators on a regular basis with stakeholders. One year from now, the HCE management system will be in place in 10% of all the Ministry of Health facilities in Uganda, providing a demonstration project for what is possible by applying standard business management techniques in a Sub-Saharan African setting.