The Ministry of Health and National Level Institutions

The core functions of the MOH are:-

1. Policy analysis, formulation and dialogue
2. Strategic planning
3. Setting standards and quality assurance
4. Resource mobilization
5. Advising other ministries, departments and agencies on health related matters
6. Capacity development and technical support supervision
7. Provision of nationally coordinated services including: health emergency preparedness and response and epidemic prevention and control.
8. Coordination of research
9. Monitoring and evaluation of the overall health sector

National Autonomous Institutions

Most functions of the MOH have been delegated to autonomous institutions. These include:- Specialized clinical services

• Uganda Cancer Institute
• Uganda Heart Institute Specialized Clinical Support Services
• Uganda Blood Transfusion Services (UBTS)
• Uganda Virus Research Institute
• National Medical Stores
• National Public Health Laboratories Regulatory bodies /authorities
• National Drug Authority
• Medical and Dental Practitioners Council
• Allied Health Professional’s Council
• Pharmacy Council
• Nurses and Midwives Council
• Uganda National Research Organization (UNHRO) coordinates national research
• Health Service Commission managers human resources for health
• Uganda Aids Commission (UAC) guides multi-sectoral response to HIV/AIDS.

Hospitals

Hospitals represent the top end of a continuum of care providing referral services, for both clinical and public health conditions to the district health services. They play an important complimentary role to primary care and constitute an important and integral part of the National Health System.

Hospital Infrastructure

In Uganda hospitals services are provided by public, private not for profit and private institutions. The degree of specialization varies between hospitals. Public hospitals are divided into three groups, according to the level of services available and their responsibilities, general, regional referral and national referral hospitals. Private hospitals are designated general hospitals, but the services they offer vary with some providing specialist services, usually found only in referral hospitals.

General Hospitals

These hospitals provide preventive, promotive, curative maternity, inpatient services, surgery, blood transfusion, laboratory and medical imaging services. They also provide service training, consultation and operational research in support of community- based health care programmes. Examples of general hospitals include Kitagata, Itojo, Ishaka Adventist and Comboni.

Regional Referral Hospitals (RRHs)

These offer specialist clinical services such as psychiatry, Ear, Nose and Throat (ENT), Ophthalmology, higher level surgical and medical services, and clinical support services (laboratory, medical imaging and pathology). They are also involved in teaching and research. This is in addition to services provided by general hospitals examples of RRHs include, Mbarara, Masaka, Fort-Potal, Mbale and KIUTH.

National Referral Hospitals

These provide comprehensive specialist services and are involved in health research and teaching in addition to providing services offered by general hospitals and RRHs.

District health care system

The 1995 Constitution and the 1997 Local Government act mandates the district local government to plan, budget and implement health policies and health sector plans, local governments have the responsibility for the delivery of health services, recruitment, deployment, development and management of human resources for district health services, development and passing of health related by laws and monitoring the overall health sector performance. The local governments manage public general hospitals and health centres and also provide supervision and monitoring of all health activities including those in the private sector in their respective areas of responsibility.

Health Sub-district

This is the immediate lower level after the district in the hierarchy of district health services organization. The Health sub-district is mandated with planning, organization, budgeting and management of health services at this and lower health centre levels.

It carries an oversight function of overseeing all curative, preventive, promotive and rehabilitative health activities including those carried out by the PNFP, and PFP service providers in the HSD. Conscious of the central role of the HSD in the delivery of the Uganda National minimum health care package (UMHCP), high priority was given to the HSD during the health care strategic plan II.

This was ensured through preferential allocation of the necessary personnel and elements of health infrastructure for making HSDs effective. The leadership of the HSD is located in an existing hospital or HC IV (Public or PNFP).

Other functions of HSD

• Provision of second level referral services for the HSD including life-saving medical surgical and obstetric emergency care (such as blood transfusion, caesarean section, and other medical and surgical emergency interventions.
• Provision of the physical base of the HSD management

Health Centre III

This is usually based at sub county level and headed by a clinical officer with the following purposes:-

• Provision of basic preventive, promotive and curative care services to communities in its catchment area
• Support supervision to HC IIs in its catchment area
• Act as first level referral services for sub counties
• Support community based activities including training and supervision of community health

Health Centre II

These are based at parishes ( ~ 500 people) and provide the following services

• They provide the first level of interaction between the formal health sector and communities
• They provide only outpatient care and community outreach services
• Health education
• Collection of basic statistics
• They are usually headed by an enrolled nurse or

Village Health Teams (H. C. I).

A network of village health teams (VHTs) has been established in Uganda which is facilitating health promotion, service delivery, community participation and empowerment in access to and utilization of health services.

Roles of VHTs

• Identifying the community’s health needs and taking appropriate measures
• Mobilizing community resources and monitoring utilization of all resources for
• Mobilizing communities for health interventions such as immunization, malaria control, sanitation and promoting health seeking behavior.
• Maintaining a register of members of households and their health
• Maintaining birth and death
• Serving as a link between the community and formal health
• Community based management of common childhood illnesses including malaria, diarrhea and pneumonia, as well as distribution of any health commodities availed from time to

The district Health Officer and district Health Management Team

The district health services are headed by a district health officer (usually a medical officer with additional training in management). Together with other health officials of the district, he is concerned with the overall management of the district health services. Other members of the district health management team usually include:-

• District Biostatistician
• District Health Educator
• District Nursing Officer
• District Stores Manager ( Medical)
• District Cold Chain Manager
• District Environmental Health officer
• District Laboratory focal person
• District Tuberculosis and leprosy supervisor
• District vector control officer
• Heads /Incharges of HSDs in the district
• Any other member deemed necessary by the

Functions of district management team

The district health officer using his district health management team is responsible for all health related activities in the district including:-

• District Planning: The DHO is responsible for coordinating all health service planning in the district in cooperation with other district officials.
• Supervision of district health activities: Supervision of all government and PNFP health facilities through regular visits,, and advice to staff concerned and ensuring that appropriate records are kept. Supervision of all special health programmes such as the expanded programme on immunization (EPI), TB and Leprosy control and family planning among others
• Training of health personnel: Any basic training in the district should be coordinated by the DHO’s office. The DHO is also responsible for the continuing education of all health staff in the district and supporting the training of community based health workers.
• Clinical work: Basing on his expertise, the DHO can also routinely take part in clinical work, especially when there is shortage of health workers.

In summary, the functions of the DHO are summarized in the scheme below;-

• Administration/supervision
• Training
• Clinical work
• Planning

Health Care setting Management Position

1. Ward In charge
2. Special Clinic In charge
3. Outreaches Coordinator
4. Records Department Director of Medical Reports
5. Nursing Senior /Principal Nursing Officer

Summary Organization of health services in Uganda

Currently health care system can be viewed as with 8 levels:

Form the top – bottom

1. The ministry of health: charged with the responsibility of setting policies and standards and guidelines, resource mobilisation, capacity building, technical supervision, monitoring and evaluation as well as overall regulation.
2. National referral hospitals: currently three (Mulago, Butabika and Mbarara)- which provide comprehensive specialist services and are involved in teaching and research.
3. Regional Referral hospitals: Serve a region – target to serve about 3 million people- offer specialist services, teaching and research.
4. District hospitals: these target to serve a district – They provide preventive, promotive, outpatient curative, maternity, inpatient health services, emergency surgery, blood transfusion, laboratory and other general services.
5. Health sub-districts and HCIV -for delivery of the minimum package to the
   • Leadership in the planning and management of health services within the HSD, including supervision and quality assurance
   • Provision of technical, logistical and capacity development support to the lower health units and communities including procurement and supply of drugs.
   • The referral facility at HSD is HCIV which could be government or
   • Such a facility offers provision of basic preventive, curative and rehabilitative care in the immediate catchments as well as functioning as referral facility for lower level units in the HSD.
6. Health center 3: The HC III offers continuous basic preventive, promotive and curative care and provides support supervision of the community and HC IIs facilities under its
7. Health center 2: Represents the first level of interface between the formal health sector and the communities.
8. Village Health Team (Health Centre I): Facilitates the process of community mobilization and empowerment for health action. Each village would have a VHT comprised of 9-10 people to be selected by the village (LCI).