The Bulamu Health Center Excellence (HCE) Program

Dick Chandler shown here with: Dr. Diana Atwine, Permanent Secretary of the MOH (in red); David Kabigumira, Chairman LC IV, Sheema District (far left); David’s wife, Jolly (in blue); and Mackay Masereka (far right), Bulamu‘s Uganda Program Director.

Part of our mission is to strengthen the health systems that serve Africans in need. A big part of that is our Health Center Excellence Program, which we launched in 2019. We installed this technology-based, hospital/clinic management system in Sheema District, with 26 public hospitals and clinics serving more than 200,000 patients a year. The HCE-IT system provides weekly dashboard reports on key performance indicators at all facilities. We are now planning to extend this train-the-trainer program to other districts.

“The HCE Program is a game-changer!” ~ From a doctor in Sheema District

The first year HCE cost of $.85 per patient is expected to drop to $.30 in subsequent years.

Why we started the HCE Program

When Bulamu treats 17,000 patients in one week at a government community hospital that would
normally serve that many patients in a year, it shows that the existing healthcare system needs
help. The challenge is: How to improve patient care at Uganda’s 3,200 public health facilities in a
cost-effective and scalable way?

We developed the HCE Program using solutions that could be implemented within the existing system by applying proven management techniques and providing relatively inexpensive, off-the-shelf medical devices. Our pilot HCE partner, Sheema District in southwestern Uganda, has 26 public facilities: 7 hospitals with from 20 to 120 inpatient beds, and 19 small outpatient clinics. Together Sheema District’s 26 health units treat over 200,000 patients per year with a total staff of 305 health workers.

We decided that the best way to improve the productivity of this staff was with new management information that gives facility managers and district officials actionable weekly data on Key Performance Indicators (KPIs) for facilities and on productivity for clinicians.

The HCE Program Implements Management Solutions at Government Health Facilities

System Weaknesses

HCE Program Solutions

Patient information: No patient treatment forms or easily accessible patient records Providing patient treatment forms and files in order to keep patient histories organized by name. One copy for patient, one for health system data and patient files at the hospital/clinic.
Equipment: Shortage of medical devices and office equipment Supplying health units with basic medical equipment (scales, stethoscopes, thermometers), diagnostic devices, computers, printers.
Clinical Practices: Not providing today’s standard of care (e.g. vital signs) New clinical procedures require taking vital signs, increased hand washing, more training.
Medicine Supply Chain: Out-of-stock medicines, unfilled prescriptions. Installing system for tracking stockouts, monitoring inventories, re-allocating supplies within District.
Staff Attendance: Absenteeism, low clinician productivity. Installing biometric time clocks. Tracking weekly attendance, “payroll yield”, clinician productivity.
Timely Data: No use of information technology for collecting actionable management data at facility level. Installing HCE-IT System, with HCE forms library, data warehouse, and suite of 14 Tableau reports. Weekly dashboard tracks 51 key performance indicators.
Culture: Little emphasis on building teamwork or a motivating culture. Providing white boards for visual management. Publishing league tables that rate health unit performance and recognizing both successes and failures.