Bulamu’s Health Center Excellence Program

Bulamu’s Health Center Excellence (HCE) program is our long-term effort to strengthen health systems and continuously improve health outcomes for the poor. HCE helps health system leaders and clinicians manage their facilities actively, including with innovative data-driven reports that do not yet widely exist in Ministry of Health systems throughout Africa.

HCE is a comprehensive hospital/clinic management system designed to improve patient care at public health facilities, while also raising staff productivity through weekly and monthly graphic management reports. Based on observing the systemic challenges that are common in Ugandan and African health systems, in 2019 we partnered with Sheema District and the Ministry of Health of Uganda to pilot the HCE program in 27 health centers, including 1 hospital.

Today, the HCE program supports 213 health centers in 11 districts that treat more than 1.6 million patients per year. By the end of 2022, HCE will scale to reach more than 300 partner Ministry of Health facilities throughout Uganda

“After two years, the HCE program has proven to be a great success…. I am therefore recommending Bulamu Healthcare to you, so you can explore partnership opportunities and collaboration…. [The MOH] and you can evaluate the programs and decide if they should be incorporated into our standard operating model.”

Dr. Diana Atwine, Permanent Secretary of Uganda’s Ministry of Health, in a 2021 letter regarding Bulamu Healthcare

HCE works through the existing Ministry of Health staff and health facilities which are already on the ground in each district, for a scalable program that dramatically improves care for the poor at a cost of less than $1 per patient supported per year. While the pandemic impacted healthcare for the poor in many ways, it did not interrupt our ability to provide the HCE system, which we have continued to improve and scale to more partner facilities throughout the pandemic.

To explore some of the HCE program’s systems in more detail, or to implement it directly,
please visit the HCE Document Library page here and then Contact Us

Selected Results:

• Since the pilot HCE was launched in Sheema, patient care has improved steadily on many fronts, and Sheema and Budaka districts have risen dramatically in Uganda’s annual District League Tables for health (from 44th and 87th to 17th and 5th, respectively).
• A patient satisfaction survey in early 2021, based on 400 exit interviews conducted at HCE partner health facilities, showed that 97% of patients would recommend their MOH health facility to family and friends. 2020 Annual Report, page 6.
• 100% of the 400 patients surveyed said they find Bulamu’s outpatient treatment form to be good (9%), very good (40%) or outstanding (51%).
• The same patient survey revealed that patient confidence in MOH facilities in HCE partner districts moved to 94% from a pre-HCE level of 59%
• In 2021, the Ministry of Health of Uganda issued 3 different support letters for Bulamu’s work. We continue to work with the MOH to integrate HCE into their national health system’s operating model by its next revision in 2024.
• HCE has improved the percent of patients having vital signs to 55% from 3% pre-HCE, or an almost 20-times improvement. 2019 Annual Report, Page 10.
• Even more importantly, HCE’s weekly and monthly management reports allow district and facility leaders to see their last 6 weeks and last 6 months of this and 57 total KPIs, to ensure that performance improves and then remains high in facilities and districts with active management.

Turning Data into Timely, Actionable Management Reports

In health systems across Africa, one of the most important missing links is timely, usable data. The monthly reports that hospitals and clinics in Uganda submit to the Ministry of Health (MOH) lack actionable management data on their performance, patient treatment effectiveness and clinician productivity. There is a gap in measurement and reporting of productivity at the health facility or clinician level, and district and facility leaders who should set priorities and drive change are not empowered with the timely, actionable data they need to do so.

Bulamu’s HCE program was founded on the principle that district leaders and in-charges of public health facilities, when provided with the right data, tools and training, can become effective managers and improve patient care at their facilities. We expect that the availability of timely reports with insights on productivity and operations for health leaders will improve clinician productivity, increase functioning operating rooms and increase standard of care practices (e.g., increased diagnosis and treatment of hypertension), among other benefits. The overall impact would be increased provision of standard of care (e.g., vital signs recorded, access to C-sections at appropriate facilities), increased patient access to and use of health services, improved patient satisfaction, and improved health outcomes such as a reduction in maternal mortality.

HCE Systems Highlights:

• 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.
• Supplying health units with basic medical equipment (scales, stethoscopes, thermometers), diagnostic devices, computers, printers.
• Installing HCE-IT System with data warehouse and suite of 23 graphic management reports. Weekly dashboard tracks 57 Key Performance Indicators.
• Management reports allow for leadership to set goals and take action based on weekly attendance and clinician productivity data, among 57 total KPIs.
• These reports also track stockouts of essential medicines, monitor inventories, and support reallocating supplies within Districts.
• Publishing league tables that rate health unit performance, allowing for timely recognition and responses to both successes and failures.

Uganda’s MOH has asked us to scale the HCE program, evaluate and document its efficacy in improving patient care, and calculate its cost as they consider incorporating HCE into the next update of Uganda’s HMIS operating model in 2024. By proving HCE’s efficacy and cost-effectiveness across a growing number of districts, we are demonstrating to the Ugandan government that these simple, technology-based solutions can be adopted at modest cost across all 3,200 government health facilities with dramatic benefits in patient care. The HCE program has great potential to scale, share lessons learned, and drive systemic change in Uganda and pan-African clinics and hospitals. Long-term, we intend to share HCE’s systems free of cost with other countries, in order to drive change and improve health systems for the poor as widely as possible.