THE UGANDA STOP MALARIA PROJECT DISTRICTS HEALTH FACILITY INTERGRATED SUPPORT SUPERVISION YEAR 5, QUARTER 1 REPORT

Transcription

1 THE UGANDA STOP MALARIA PROJECT DISTRICTS HEALTH FACILITY INTERGRATED SUPPORT SUPERVISION YEAR 5, QUARTER 1 REPORT JANUARY 2013

2 TABLE OF CONTENTS LIST OF ACRONYMS... 3 Executive Summary Background to Malaria in Uganda Background to the Stop Malaria Project Integrated Support Supervision to Health facilities in SMP supported Districts MALARIA PREVENTION Prevention of Malaria in pregnancy Availability of SP in ANC Clinics Health Educational Talks about Malaria during ANC Clinics CASE MANAGEMENT... Error! Bookmark not defined Clinical Audits... Error! Bookmark not defined Availability of ACT Stocks... Error! Bookmark not defined Malaria treatment according to the national malaria guidelines. Error! Bookmark not defined LABORATORY MANAGEMENT... Error! Bookmark not defined Lab maintenance log... Error! Bookmark not defined. 3.4 SUPPORT SUPERVISION TO HEALTH FACILITIES... Error! Bookmark not defined Support Supervision from upper levels... Error! Bookmark not defined Health Facilities that Conducted SS to lower Levels... Error! Bookmark not defined. 3.5 HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS)... Error! Bookmark not defined Health Facilities Recording Accurate Data... Error! Bookmark not defined. Figure 14 Trends in proportion of facilities recording accurate data... Error! Bookmark not defined Health Facilities Analyzing and Utilizing Data for Decision Making... Error! Bookmark not defined. 3.6 CONTINUOUS MEDICAL EDUCATION... Error! Bookmark not defined. Table 10: Proportion of Hospitals Recording Accurate Data TABLE 13: PERFORMANCE BASED ON KEY CRITERIA INDICATORS BY DISTRICTS BY HEALTH FACILITY LEVEL... 44

3 LIST OF ACRONYMS ACT ANC BCC CCP CDFU DHI DHO DHT DOTs HA HF HSD HMIS IDI IEC IPTp ISS JHU LLIN MC MoH NMCP NMS PMI PNFP QI RDT SMP Artemisinin- based Combination Therapy Antenatal Care Behaviour Change Communication Johns Hopkins Bloomberg School of Public Health Center for Communication Programs Communication for Development Foundation Uganda District Health Inspector District Health Officer District Health Team Directly Observed Treatment Health Assistants Health Facility Health Sub District Health Management Information Systems Infectious Diseases Institute Information, Education and Communication Intermittent Preventive Treatment in pregnancy Integrated Support Supervision Johns Hopkins University Bloomberg School of Public Health Long Lasting Insecticide Treated Net Malaria Consortium Ministry of Health National Malaria Control Program National Medical Stores President s Malaria Initiative Private Not for Profit Quality Improvement Rapid Diagnostic Testing Stop Malaria Project

4 SP ToT UHMG USAID Sulfadoxine- pyrimethamine Training of Trainers Uganda Health Marketing Group United States Agency for International Development

5 Executive Summary SMP continues to assess health facilities in the area of ANC/IPTp services, case management, laboratory diagnosis, drug verification, HMIS systems, IEC verification and support supervision to lower health facilities. The quarter 1, year 5 support supervision was carried out in the months of November and December 2012 in 672 health facilities (308 HCIIs, 283 HCIIIs, 52 HCIVs and 29 Hospitals) in 34 districts and conducted from November through to December 2012 with data from August to October 2012 under review. There was an improvement in IPTP2 uptake from 52% in Year 4, quarter 4 to 58% in Year 5, quarter 1 in facilities supervised that offer ANC services. However, this was below the IPTp2 target of 60%. The findings of ISS in the quarter also showed a high percentage of health facilities reporting no stockout of SP (94%) in health facilities visited although this was a slight decline from previous quarter which was at (96%). Ninety two (92%) of all health facilities visited during the quarter reported availability of IPTp commodities compared to 91% the previous quarter. Ninety nine (99%) of Hospitals and HCIVs visited during ISS had IPTp commodities available. The findings indicate a fewer lower level ANC health facilities with IPT commodities. The proportion of facilities giving ANC health education talks was 89% (see Table 5 in Appendices) compared to 90% in the previous quarter. The proportion of facilities conducting ANC health education talks was 92% and 93% for hospitals and HC IVs respectively and 90% and 88% for Health Centre IIIs and Health Centre IIs respectively indicating a likelihood of few lower health facilities not conducting ANC health education talks. There was an increase in the percentage of Hospitals and HCIVs that carried out clinical audit up from (63%) to (77%). ACT stock outs improved from (87%) in the previous quarter to (89%). Percentage of HFs reporting accurate data increased from (71%) to (75%), and data analysis and utilization from (44%) to (49%). Mpigi continues to be one the best performing districts across all indicators. While there is observed progress in some indicators since the start of the project, there is need for continued support to the districts for further improvement, and especially in indicators such

6 as ACT stock outs and clinical audit, and data for decision making where SMP target has not yet been achieved.

7 1.0 Background to Malaria in Uganda Malaria is a major public health problem and the most frequently reported disease at both public and private health facilities in Uganda. Clinically diagnosed malaria is the leading cause of morbidity and mortality, accounting for 25-40% of outpatient visits at health facilities, 15-20% of all hospital admissions, and 9-14% of all hospital deaths. Nearly half of inpatient deaths among children under five years of age is attributed to clinical malaria. A significant percentage of deaths occurs at home and goes unreported by the facility- based Health Management Information System (HMIS). Malaria is not only a health problem but also a development problem. In economic terms, treatment of severe episodes can cost up to one- quarter of a household s monthly income and accounts for up to 40% of public sector health expenditures in Uganda. Malaria affects land use patterns and crop selection resulting in sub- optimal agricultural production, and reduces labour productivity through lost workdays and diminished on- the- job performance. Malaria also affects learning and educational attainment through absenteeism from school and through cognitive impairment related to its chronic impact on the body. Severe malaria causes permanent neurological damage. 2.0 Background to the Stop Malaria Project The Stop Malaria Project (SMP) is a five- year program ( ) of development assistance funded by the Presidential Malaria Initiative and the United States Agency for International Development (USAID). 1. The project is designed to contribute to USAID/Uganda s Development Objective of improved health and nutrition status in focus areas and population groups. Specifically, the project assists the Government of Uganda to reach the PMI and Roll Back Malaria (RBM) goal of reducing malaria related mortality by 70%. 2. To help achieve this goal, SMP uses an integrated set of approaches that reaches recipients at multiple levels, including behavioural change interventions at the individual, household, and community levels; service delivery strengthening at the health facility level; and institutional capacity- building at the district and national levels.

8 During the five years, the project endeavors to reach 85% coverage of children under five years of age and pregnant women in the project area districts with proven preventive and therapeutic interventions: 1. Artemesinin- based Combination Therapy (ACT) for treatment of uncomplicated malaria 2. Intermittent Presumptive Treatment (IPTp) of malaria in pregnancy, and 3. Long- lasting Insecticide- treated nets (LLINs). The objectives of the Stop Malaria Project are to support the Government of Uganda through the National Malaria Control Program (NMCP) strategies in three result areas: 1. To improve malaria prevention programs in support of the national malaria strategy. 2. To improve malaria diagnosis through laboratory strengthening and treatment activities 3. To strengthen the capacity of the NMCP, thus improving the monitoring, evaluation, supervision, documentation and reporting of malaria activities. 3.0 Integrated Support Supervision to Health facilities in SMP supported Districts The Stop Malaria Project provides financial and technical support to districts to carry out integrated support supervision every quarter as a way of monitoring and evaluating project activities in the health facilities. The purpose of the support supervision is to assess the capacity and gaps of health facilities in controlling and treating malaria- related cases. The assessment focuses on issues related to availability of services, quality of services, and utilization of services. In response to performance gaps, specific action plans to address the gaps are developed with the health facility staff. SMP continues to assess health facilities in the area of ANC/IPTp services, case management, laboratory diagnosis, drug verification, HMIS systems, IEC verification and support supervision to lower health facilities. The quarter 1, year 5 support supervision was carried out in the months of November and December 2012 in 672 health facilities (308 HCIIs, 283 HCIIIs, 52 HCIVs and 29 Hospitals) in 34 districts. This quarter s ISS visits were conducted in November to December 2012 and data from August to October 2012 was reviewed. For purposes of tracking project performance using support supervision data, Hospital and HC IVs will be considered since all hospitals and HC IVs have to be supervised every quarter.

9 Table 1: List of Districts by Health Facility Level that were visited during ISS CENTRAL ZONE HCII HCIII HCIV HOSP Total HOIMA ZONE HCII HCIII HCIV HOSP Total Buikwe Bulisa Bukomansimbi Hoima Butambala Kibaale Buvuma Kiboga Gomba Kiryandongo Kalungu Kyankwanzi Kayunga Masindi Luwero SUB- TOTAL Lwengo TESO ZONE Masaka Amuria Mityana Bukedea Mpigi Kaberamaido Mubende Katakwi Mukono Kumi Nakaseke Ngora Nakasongola Serere Rakai Soroti Sembabule SUB- TOTAL Wakiso SUB- TOTAL Overall Totals

10 3.1 MALARIA PREVENTION Prevention of Malaria in pregnancy According to the ministry of health policy, pregnant women are supposed to take at least two doses of fansidar to help them prevent getting malaria in pregnancy. The Stop Malaria Project promotes the MOH comprehensive reproductive health package of using Directly Observed Treatment (DOT), among pregnant women attending public as well as private not for profit health facilities which is part of focused ANC services. The Project targets pregnant women for LLIN distribution and IPTp uptake through ANC services. LLIN distribution through ANC has been ongoing since May 2011; this is expected to increase the protection of this vulnerable group against malaria. Figure 1: Proportion of Hospitals & HC IVs regionally that achieved IPTp Uptake above 60% Proportion of Hospitals & HC IVs with IPTp Uptake above 60% Central 21% Hoima 40% Teso 39% A target of 60%, was set as a benchmark for measuring performance in each of the Hospitals and HC IVs, and results in Figure 2 above shows that regionally, Hoima (40)%) had the highest number of Hospitals and HC IVs with uptake of 2 doses of SP above 60%, compared to Teso region (39%) and Central region with the lowest (21%).

11 Figure 2: Average % of pregnant women who attended first ANC and received two doses of IPTp in health facilities visited during ISS 100% 80% 60% 40% 48% 48% 54% 53% 54% 52% 53% 52% 58% IPTp2 20% IPTp 2 Target = 60% 0% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Year3 Year 4 Year 5 There was an improvement in IPTP2 uptake from 52% in Year 4, quarter 4 to 58% in Year 5, quarter 1 in facilities supervised in the quarter that offer ANC services. However, this was below the IPTp2 target of 60%. SMP will continue to track availability of SP and IPTp commodities in order to increase uptake of IPTp1) In addition, SMP will continue to provide on job mentorhip in proper data recording, PNFP health facilities will be guided on how best to use their PHC funds to procure SP. Regionally Regionally, IPTP2 uptake was highest in Teso 65% followed by Hoima (57%) and central with the lowest (53%). The findings show an increase from previous quarter across all the regions. District At District level, Kumi district had the highest percentage (86%) of pregnant women who received at least two doses of IPTp2. Sembabule (43%) and Buvuma (43%) had the lowest percentages of pregnant women who received at least two doses of IPTp2.

12 Health Facility Level At health facility level, Uptake of at least 2 doses of IPTp2 by facility ownership status was at 56% for public facilities, 56% for NGO facilities and 53% for private for profit facilities during the quarter. The findings show pregnant mothers who attended first ANC and received at least two doses was highest in HC III (60%) followed by hospitals (59%), HCIVs (54%) and 52% for HCII. Stop Malaria Uganda (SMP) will continue to track availability of SP in all facilities in order to increase uptake. On job mentoring on proper data recording will be promoted during review meetings at district, regional levels and during support supervision Availability of SP in ANC Clinics Uptake of IPTp services highly depends on the availability of SP in the ANC clinics, and thus SMP tracks the availability of stocks to ensure timely interventions in the event of stock outs. Figure 3 Average percentage of health facilities reporting no stock out of SP 120% % of health facili`es repor`ng no stock out of SP 100% 80% 90% 88% 92% 91% 91% 93% 83% 96% 94% 60% 40% Actual Target = 95% 20% 0% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Year3 Year 4 Year 5 SMP continue to track availability of SP stocks during intergrated support supervison. The findings of ISS in the quarter show a high percentage of health facilities reporting no stockout of SP (94%) in health facilities visited although this was a slight decline from previous quarter which was at (96%)

13 Regionally Regionally, 95% of the facilities in Central Region in the quarter and same as previous quarter reported not having stock out of SP. Hoima region had 96% of facilities reporting no stockout of SP compared to 99% in the previous quarter and Teso Region had 92% of health facilities reporting no stock out of SP compared to 93% in the previous quarter. This regional trend analysis shows that Teso Region has consistently experienced slightly lower SP stocks compared to the other regions. District At district level, districts of Gomba, Kalungi, Kayunga, Mityana, Mpigi and Naksongola districts in Central Uganda; Mubende, Hoima, Kiboga, Kiryandongo and Masindi districts in Hoima region and only Katakwi and Soroti for Teso Region had 100% of their facilities reporting no SP stock out. Ownership Figure 4. SP availability by ownership 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% SP AVAILABLE IN CLINIC BY OWNERSHIP 98% 88% 84% Govt NGO PFP Govt NGO PFP above findings that SP stockouts are prone in PNFP and PFP facilities. From the ISS findings, it was noted that more private for profit health facilities (84%) reported no stockouts of SP compared to public facilities (98%) and NGO facilities (88%). It can be deduced from the At health facility level, the findings show majority of hospitals (99 %) and HC IVs (98%) compared to lower level facilities visited reported no stock outs of SP during the months of August, September, and October Ninety four (94%) of all ANC clinics supervised reported

14 no stock out of SP in the facilities. From the findings, more SP stock outs were experienced at lower levels than hospital and HC IV. Stop Malaria Project will track SP availability at both lower and upper level facilities and liaise with district health offices on redistribution of SP from facilities that have more than enough to those that are in dire need to increase uptake Availability of IPTp Commodities in ANC Clinics Figure 5. Percentage of ANC facilities with IPTp commodities 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Percentage of ANC facilities with IPT Commodities 90% 90% 90% 90% 90% 90% 90% 90% 90% 94% 90% 91% 92% 82% 85% 80% 73% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Year3 Year 4 Year 5 The ISS findings in figure 5 show that 92% of all health facilities visited during the quarter reported availability of IPTp commodities compared to 91% the previous quarter. Further analysis (see Table 4) indicates that 99% of Hospitals and HCIVs visited during ISS had IPTp commodities available. All hospitals and HCIVs in Teso and Hoima regions had IPTp commodities. In Central region, percentage of health facilities that had IPTP commodities was at 97% and 98% for hospitals and HCIVs respectively. The findings indicate fewer lower level ANC health facilities with IPT commodities. Through support supervision, SMP will continue to monitor and track availability of IPTp commodities at all health facilities.

15 Health Educational Talks about Malaria during ANC Clinics Health education talks about malaria prevention during ANC are conducted to ensure that mothers are aware of the importance of sleeping under a mosquito net and take atleast 2 doses of IPTp. During the ISS conduted in the quarter, the proportion of facilities giving ANC health education talks was 89% (see Table 5 in Appendices) compared to 90% in the previous quarter. The proportion of Hospitals conducting ANC health education talks was 92% and 93% for HC IVs For lower level facilities, the proportion of health facilities condicting ANC health education talks was 90% and 88% for Health Centre IIIs and Health Centre IIs respectivelythis finding indicate that there is a likelihood of few lower health facilities not conducting ANC health education talks. Regionally Teso and Central had 89% of all their facilities giving ANC health education talks while Hoima region had 90% of all their facilities giving ANC health education talks. This particular indicator was more or less the same across all SMP regions District Buvuma district (78%), Mityana (75%), Gomba (75%), Amuria district (71%) and Bukomansimbi (57%) were among the districts with the least proportion of facilities providing ANC health education talks. Stop malaria will continue to engage with the health workers during support supervision on the importance of giving ANC health education talks. Ownership In terms of ownership, the PFPs had a slightly higher percentage (95%) of all their facilities giving ANC health education talks followed by the government facilities (90%) and then PNFP facilities (89%).

16 3.2 CASE MANAGEMENT Clinical Audits Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. The clinical audit process seeks to identify areas for health service improvement, develop and carry out action plans to rectify or improve service provision and then to re- audit to ensure that these changes have an effect. SMP provides technical and financial support to district clinical audit teams to carry out the clinical audit approach for the improvement of severe malaria management. Clinical audits target health facilities that manage severe malaria (Hospitals and HCIVs). ISS findings showed an increase (77%) in the number of facilities that conducted clinical audit during the quarter up from 63% in the previous quarter. More Hospitals (79%) visited during ISS had conducted clinical audits compared to HCIVs (75%). Regionally, Hoima and Teso had an increase in the number facilities conducting clinical audit (92%) and (81%) respectively, while central region showed a decline from 61% in the previous quarter to (57%) in the reporting quarter. Bukomasimbi, Butambala, Gomba, Lwengo, Mpigi, Buliisa, Kiboga, Kiryandongo, Kyankwanzi, Masindi, Bukedea, Kaberamaido, Katakwi, Ngora, and Serere districts had their entire facilities (100%) conduct clinical audit whereas Mityana, Mukono and Sembabule had no HF that conducted clinical audit during the quarter. More Hospitals (79%) than HC IVs (75%) conducted clinical audits during the quarter. Figure 6 Trends in Clinical Audits

17 Findings in Figure 6 shows up and down ward trend in clinical audits in SMP districts. And in all the quarters SMP target has not yet been achieved. In order to address this gap SMP will continue to encourage districts and emphasize the importance of carrying out clinical audits Referral of Emergency Cases As part of case management of severe malaria cases, HC IIIs and HC IIs are supposed to give pre- referral treatment to patients diagnosed with severe malaria before referring them to higher- level health facilities. Figure 7 Proportion of children under 5 who were first given pre- referral treatment before being referred to higher level facilities Findings from Figure 7 above indicate the proportion of children under 5 who were first given pre- referral treatment before being referred to higher level facilities declined from 54% in the previous quarter to 41% in this quarter.

18 Regional level Teso region (49%) continues to have the highest number of referrals for under five who are first given pre- referral treatment while central region has the lowest. District level Districts with the highest percentage of children under five who were first given pre- referral treatment before being referred to high levels for treatment included Serere (80%), and Kaberamaido (70%). Those with the lowest percentage of children referred included Mpigi (15%), Kiboga (20%), Sembabule and Bukomansimbi (23%), Masaka (25%), Bukedea (27%), and Kalungu (28%). Findings further show that Buvuma (0%) did not offer any pre- referral treatment Availability of ACT Stocks Availability of ACTs in all health facilities is critical to the effective management of malaria. To ensure their continued availability in the facilities, SMP on a weekly and monthly basis tracks ACT stocks in the facilities and works in collaboration with the SURE project to ensure that there are no stock outs. Figure 8 Trends in percentage of facilities reporting no ACT Stock outs According to the ISS findings in Figure 8 above, there was a slight increase (89%) in the number of facilities reporting no stock outs from (87%) in the previous quarter. Regional Level

19 Hoima region (93%) continued to have the highest number of facilities reporting no ACT stock out followed by Central (92%), and Teso regions (83%). District Level Katakwi and Mukono districts (100%) had all their facilities reporting no ACT stock outs. While Ngora (67%) and Serere (69%) had the lowest number of facilities reporting no ACT stock outs. Health Facility Level Hopsitals (100%) did not experience ACT stock outs, HCIIIs and HCIIs at (92%), while HCIVs were at (91%). SMP will continue to encourage district health teams in the districts worst hit by the ACT stock outs to arrange for redistribution of stocks from facilities which have adequate supplies to those with stock outs, as they await new supplies from the National Medical Stores. SMP continues to advocate for the rational use of ACTs by encouraging and promoting use of rapid diagnostic tests. Stock outs in some facilities and districts is linked to irrational use of ACTs where tests are not conducted to rule out malaria and patients are simply given ACTs once they present with signs and symptoms of Malaria. Figure 9 Regional Performance - ACT stock outs

20 3.2.4 Malaria treatment according to the national malaria guidelines In Febuary 2012, MoH approved the Artemisinin based combination therapy (ACTs) as the first line treatment for uncomplicated malaria, IV artersunate or parenteral quinine as the treatment for severe malaria and complicated malaria. During the quarterly support supervision, SMP monitors health facilities to ensure that health workers are treating based on these malaria treatment guidelines. ISS findings from Figure 10 below show that majority of the health facilities supervised (95%) had health workers who followed the national treatment guidelines, an increase from (91%) in the previous quarter. Figure 10 Average % of HWs giving treatment according to National Malaria treatment guidelines Regional Level Teso (94%) continues to perform well with most of her facilities treating according to National malaria guidelines, followed by Hoima (93%) and central (91%). District Level The following districts had all (100%) their facilities treat according to national malaria guidelines Bukedea, Kaberamaido, Katakwi, Kumi, Serere, Buliisa, Nakasongola, Mpigi, Gomba, Butambala and Bukomansimbi.

21

22 3.3. LABORATORY MANAGEMENT Improving laboratory services and promoting accurate diagnosis of malaria at community level saves lives and prevents wastage of valuable resources especially ACTs. The importance of accurate diagnosis of all the major diseases cannot be underestimated, and efficient laboratory testing is vital to identifying and treating life- threatening illnesses. Laboratory services in many rural areas are often run down and yet they are critical for public health, disease control and surveillance as well as guiding patient diagnosis and care. Poor quality laboratory services have the greatest negative impact on poor and vulnerable people because these people carry the largest burden of ill health. The effective diagnosis of malaria and other life- threatening illnesses at both community and laboratory level helps in reducing this burden. According to the national health system, all, HCIVs and hospitals are expected to a functional laboratory or designate place for carrying out laboratory tests. It is important to note that this indicator was assessed in health facilities that have functional laboratory using microscopes. During the trainings and support supervision, SMP emphasizes the need to have maintenance logs to minimize on equipment breakdown Lab maintenance log Depending on their use, microscopes should receive routine service once, twice, or even four times a year. Microscopes need complete cleaning of all optical surfaces, lubrication of all moving mechanisms, adjustments and realignments and thorough cleaning of all external surfaces. Repairs and replacement of Power Cords, Outlets and Voltage many times are required. Since most users are not trained in handling and maintenance of these delicate Machines breakdowns are expected. ISS findings in Figure 11 below show an increase (53%) in the number of facilities with a lab maintenance log, from 49% in the previous quarter. A significant number of hospitals (89%) supervised had a lab maintenance log compared to health centre IVs (77%). Figure 11 Percentage of health facilities with a functional lab that has a maintenance log

23 Regional level Regionally Hoima (62%) continues to have the highest proportion of facilities with a lab maintenance log, with Central and Teso both trailing at (49%). District Level Mpigi district (100%) had all its facilities with a lab maintenance log, while Sembabule (14%) had the lowest. SMP will continue to emphasize the need to have maintenance logs.

24 3.4 SUPPORT SUPERVISION TO HEALTH FACILITIES Support Supervision from upper levels According to the MoH support supervision guidelines, lower health facilities are supposed to be supervised by the immediate upper level health facilities. For instance hospitals and HC IVs are supposed to be supervised by District Health Team (DHT), and a HC III by HC IV/Hospital and/ or DHT. Figure 12: Proportion of Health Facilities that were supervised by Upper Levels During support supervision, health facilities are assessed to establish whether they were supervised, this is done by reviewing the supervision reports and books at the facility. Findings in Figure 12 above show that all Hospitals (100%) received supervision from upper levels, followed by HC IVs and HC IIIs at (96%), and HCII (95%). Most of the facilities mentioned receiving support supervision from the district health supervisors. It is important to note that support supervision plays a critical role in the improvement of service delivery, and skills of health workers. SMP will therefore continue to encourage district health offices to carry out support supervision.

25 3.4.2 Health Facilities that Conducted SS to lower Levels Figure 13: Proportion of Health Facilities that Conducted SS to lower Levels ISS findings in Figure 13 above shows that the number of HFs that carried out support supervision to lower levels increased in HCIIs, HCIIIs and HC IVs, except Hospitals where adecline was observed from (74%) in the previous quarter to (70%) in the reporting quarter.

26 3.5 HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS) The Health Management Information System collects data from all health facilities in the public and not- for profit private sector with respect to curative as well as preventive services. The Health Sector strategic investment plan aims at improving the collection, quality and utilization of routine data to monitor the implementation of interventions hence SMP supervised the existence of HMIS at facility level. During support supervision the team reviewed the existence of data registers at the facilities for consistence and data accuracy of the HMIS data i.e.what was submitted to the district against the count in the OPD, ANC, and Lab registers Health Facilities Recording Accurate Data Data accuracy and validity is very critical to evidence based reporting, planning, resource allocation and quantification of health facility supplies. During support supervision, data in the primary source documents is tallied against the summary forms to rule out cases of inaccuracy. Figure 14 Trends in proportion of facilities recording accurate data ISS findings in Figure 14 show 75% of the health facilities supervised during the quarter were found to be reporting accurate HMIS data, compared to 71% in the last quarter. Regional level

27 Regionally, Hoima region had the most accurate data reported (80%), followed by central (79%) while Teso region had the lowest health facilities submitting accurate HMIS data (66%) to the district level. The ISS findings this quarter show an improvement facilities reporting accurate data from last quarter in Teso (60%) and Hoima (75% ) region; to 66% in Teso and 80% in Hoima region.. District level Districts with most accurate data include Mpigi (100%), Kiboga (94%), Gomba (94%) and Masaka (93%). While Kumi (42%), Mukono (47%), and Katakwi (58%) had less accurate data. The improvement in accuracy of data is attributed to the Data Quality Assessment and Data Use trainings supported and conducted by SMP and MoH Resource Center. Health Facility Level More accurate was found to be in HCIVs (83%), whereas HCIIIs (73%) had less accurate data. SMP is supporting districts to conduct data use meetings, this provides a platform for the district to review its performance and come up with recommendations for improvement in data collection, analysis and reporting by HFs Health Facilities Analyzing and Utilizing Data for Decision Making Part of the SMP support towards districts and health facilities is geared towards improving HMIS data collection, analysis and use. Data analyzed and shown on graphs for the key health sector indicators are used as a measure for data analysis and use at the health facility. Figure 15 Proportion of Health Facilities Analyzing and Utilizing Data for Decision Making

28 ISS findings during the quarter as in Figure 15 above indicate that overall data analysis and utilization of HMIS data has improved from 44% in the last quarter to 49%, this is largely attributed to the trainings on data quality assessment and data demand and use supported by Stop Malaria Project. Regional level ISS findings show that regionally central commendable improvement in the proportion of health facilities (54%) analyzing and utilizing data, compared to (41%) in the last quarter. District level Gomba (84%), Ngora (83%), and Mpigi (80%), were the best performing districts. Kalungu declined from 52% in the previous quarter to (16%). Other poor performing districts include Katakwi (23%), Buliisa (30%), Amuria (33%), Hoima(32%), Mityana(32%) and mubende (32%). Health Facility Level HCIVs (68%) had most of its data analyzed and utilized, followed Hospitals (67%), HCIIIs (54%), and HCIIs (39%). Stop Malaria project will continue to support the districts to conduct quarterly DQAs and data use meetings a means of improving data analysis and utilization.

29 3.6 CONTINUOUS MEDICAL EDUCATION According to the ministry of health, every health facility is supposed to conduct continuous medical education every month. This helps health workers to be refreshed on many aspects regarding treating and caring for their patients. During the ISS, SMP set out to assess whether health facilities were conducting CMEs. Figure 16.Proportion of Health Facilities that conducted CME during the quarter According to ISS findings in Figure 16 above,60% of all health facilities visited conducted CMEs during the quarter compared to 92% previous quarter. Regional level Regionally central (66%) had the most number of facilities conducting CMEs, followed by Teso (57%), and Hoima (56%). District level analysis Buikwe (93%) had most of her facilities conducting CMEs, and Buvuma (29%) had the lowest percentage. Health facility level

30 All hospitals visited during ISS conducted CMEs. SMP will continue to emphasis the need to carry out CMEs during support supervisions and regional review meetings, as well as other interfaces with the district.

31 Appendices Table 2: Average % of pregnant women who attended first ANC and received two doses of IPTp in health facilities visited during ISS Central Region Hospitals & HC IVS Supervised Facilities Supervised No. of Hosp Average % of PW No. of HCIVs Average % of PW No. of Hosp & HC IVs Average % PW (Hosp, HCIvs, HCIII, HCII) Buikwe 4 60% % 25 52% Bukomansimbi % 1 51% 14 53% Butambala 1 43% % 12 46% Buvuma % 1 43% 9 43% Gomba % 1 44% 13 56% Kalungu 1 54% 2 66% 3 60% 24 53% Kayunga 1 68% 3 52% 4 60% 24 55% LWENGO % 3 70% 22 54% Masaka 2 43% 2 32% 4 38% 27 50% Mityana 1 27% 2 41% 3 34% 28 55% Mpigi 1 70% 1 66% 2 68% 20 56% Mubende 1 51% 3 47% 4 49% 35 54% Mukono % 2 53% 17 55% Nakasongola 1 40% 2 60% 3 50% 31 71% Rakai 2 57% 2 24% 4 40% 46 54% Sembabule % 2 28% 20 43% Wakiso 5 65% 5 34% 10 49% 27 49% Central Average 20 53% 32 49% 52 49% % Hoima Region Buliisa % % Hoima 1 79% 3 69% 4 74% 30 53% Kiboga 1 76% 1 94% 2 85% 13 55% Kiryandongo 1 72% % 12 69% Kyankwanzi % 1 45% 16 44% Masindi 1 67% 2 32% 3 50% 29 53% Hoima Average 4 74% 8 65% 12 65% % Teso Region Amuria % 2 70% 15 62% Bukedea % 1 70% 9 72% Kaberamaido 1 40% % 13 50% Katakwi 1 61% 1 62% 2 61% 13 61% Kumi 2 78% 1 124% 3 101% 13 86% Ngora 1 58% 1 58% 11 81% SERERE % 1 43% 17 57% SOROTI % 2 53% 16 50% Teso Average 5 59% 8 71% 13 60% % SMP AVERAGE 29 62% 48 62% 77 58% % No. of HFs Average % of PW

32 Table 3: Average % of ANC clinics reporting no stock outs of SP No. of Average No. Average No. of Average % of No. Average % Hosps % of of HC % of HC Hosps & Hosps & HC of of HFs Hosps IVs Ivs HC Ivs Ivs HFs Central Region Buikwe 4 100% % 24 92% Bukomansimbi % 1 100% 13 92% Butambala 1 100% % 12 83% Buvuma % 1 100% 7 86% Gomba % 1 100% % Kalungu 1 100% 2 100% 3 100% % Kayunga 1 100% 2 100% 3 100% % LWENGO % 3 100% 22 82% Masaka 2 100% 2 100% 4 100% 26 96% Mityana 1 100% 3 100% 4 100% % Mpigi 1 100% 1 100% 2 100% % Mubende 1 100% 3 100% 4 100% % Mukono % 2 100% % Nakasongola 1 100% 2 100% 3 100% % Rakai 2 100% 2 50% 4 75% 44 95% Sembabule % 2 50% 20 95% Wakiso 5 80% 5 80% 10 80% 26 88% Central Average 20 98% 32 95% 52 94% % Hoima Region Buliisa % Hoima 1 100% 3 100% 4 100% % Kiboga 1 100% 1 100% 2 100% % Kiryandongo 1 100% % % Kyankwanzi % 1 100% 16 88% Masindi 1 100% 2 100% 3 100% % Hoima Average 4 100% 7 100% % % Teso Region Amuria % 2 100% 15 87% Bukedea % 1 100% 9 89% Kaberamaido 1 100% 1 100% 2 100% 14 93% Katakwi 1 100% 1 100% 2 100% % Kumi 2 100% 1 100% 3 100% 13 92% Ngora 1 NDA 1 100% 2 100% 11 91% SERERE % 1 100% 17 88% SOROTI % 1 100% % Teso Average 5 100% 9 100% % % SMP AVERAGE 29 99% 48 98% 77 98% %

33 Table 4: Average percentage of ANC Clinics reporting availability of IPTp Commodities No. of Average % No. of Average % No. of Average % No. Average % Hosps of Hosps HC IVs of HC Ivs Hosp & of Hosp & of of HFs HC Ivs HC Ivs HFs Central Region Buikwe 4 100% % 25 84% Bukomansimbi % 1 100% 12 83% Butambala 1 100% % 10 90% Buvuma % 1 100% 9 100% Gomba % 1 100% % Kalungu 1 100% 2 100% 3 100% % Kayunga 1 100% 3 100% 4 100% 24 96% LWENGO % 2 100% 19 95% Masaka 2 100% 2 100% 4 100% 26 69% Mityana 1 100% 3 67% 4 83% 28 86% Mpigi 1 100% 1 100% 2 100% % Mubende 1 100% 3 100% 4 100% 34 79% Mukono % 2 100% % Nakasongola 1 100% 2 100% 3 100% 31 97% Rakai 2 100% 2 100% 4 100% 44 82% Sembabule % 2 50% % Wakiso 3 67% 3 100% 6 83% 23 83% Central Average 18 97% 30 98% 48 95% % Hoima Region Buliisa % 1 100% 8 100% Hoima 1 100% 3 100% 4 100% 29 97% Kiboga 1 100% 1 100% 2 100% 11 82% Kiryandongo 1 100% % % Kyankwanzi % 1 100% 15 80% Masindi 1 100% 2 100% 3 100% 28 96% Hoima Average 4 100% 8 100% % % Teso Region Amuria % 2 100% % Bukedea % 1 100% 9 78% Kaberamaido 1 100% % % Katakwi 1 100% 1 100% 2 100% % Kumi 2 100% 1 100% 3 100% 11 92% Ngora % 1 100% 11 91% SERERE % 1 100% 16 88% SOROTI % 1 100% 16 81% Teso Average 4 100% 8 100% 12 94% % SMP AVERAGE 26 99% 46 99% 72 96% %

34 Table 5: Proportion of facilities giving ANC health education Talks Districts Hospitals & HC IVS Supervised Facilities Supervised (Hospitals, HC Ivs, HC III, HC II) No. of Hosps Average % of Hospitals giving ANC HE Talks No. of HC IVs Average % of HC IVs giving ANC HE Talks No of Hospit als & HC IVs Average % of Hosps HC IVs giving ANC HE Talks No. of HFs Buikwe 4 100% % % Bukomansimbi % 1 100% 14 57% Butambala 1 100% % % Buvuma 0 1 0% 1 0% 9 78% Gomba % Kalungu 1 100% 2 100% 3 100% % Kayunga 1 100% 3 100% 4 100% 23 96% LWENGO % 3 100% 23 91% Masaka 2 100% 2 100% 4 100% % Mityana 1 100% 3 100% 4 100% 28 75% Mpigi 1 100% 1 100% 2 100% % Mubende 1 100% 3 67% 4 83% 34 97% Mukono % 2 100% 16 81% Nakasongola 1 100% 2 100% 3 100% 31 97% Rakai 2 100% 2 100% 4 100% 44 84% Sembabule % 1 100% 18 89% Wakiso 5 100% 5 100% % 27 93% Central Region Average % 31 90% 51 93% % Hoima Region Buliisa % 1 100% 9 100% Hoima 1 100% 3 100% 4 100% 30 87% Kiboga % 1 50% % Kiryandongo 1 100% % 11 82% Kyankwanzi % 1 100% 16 88% Masindi 1 100% 2 50% 3 75% 29 83% Hoima Region Average 3 100% 8 90% 11 88% % Teso Region Amuria % 1 100% 14 71% Bukedea % 1 100% 8 88% Kaberamaido 1 100% % % Katakwi % 1 50% 11 91% Kumi 2 50% 1 100% 3 75% 12 92% Ngora % 1 100% % SERERE % 1 100% 17 94% SOROTI % 1 100% 15 80% Teso Region Average 3 75% 7 100% 10 84% % SMP AVERAGE 26 92% 46 93% 72 88% % Average % of facilities giving ANC HE Talks

35 Table 6: Percentage of hospitals and HC IVs that conducted clinical audits Districts Hospitals & HC IVS Supervised Central Region No. of Hospitals Average % of Hospitals who conducted Clinical Audits No. of HC IVs Average % of HC IVs who conducted Clinical Audits No. of Hospitals & HC IVs Buikwe 4 25% % Bukomansimbi % 1 100% Butambala 1 100% % Buvuma % 2 50% Gomba % 1 100% Kalungu 1 0% 2 100% 3 50% Kayunga 1 100% 3 50% 4 75% Lwengo % 3 100% Masaka 2 50% 2 100% 4 75% Mityana 1 0% 3 0% 4 0% Mpigi 1 100% 1 100% 2 100% Mubende % 3 33% Mukono 0 2 0% 2 0% Nakasongola 1 100% 2 50% 3 75% Rakai 2 100% 2 0% 4 50% Sembabule 0 2 0% 2 0% Wakiso 5 40% 5 40% 10 40% Central Region Average 19 62% 34 55% 53 57% Hoima Region Buliisa % 1 100% Hoima 1 0% 3 100% 4 50% Kiboga 1 100% 1 100% 2 100% Kiryandongo 1 100% % Kyankwanzi % 1 100% Masindi 1 100% 2 100% 3 100% Hoima Region Average 4 75% 8 100% 12 92% Teso Region Amuria % 2 50% Bukedea % 1 100% Kaberamaido 1 100% % Katakwi 1 100% 1 100% 2 100% Kumi 2 100% 1 0% 3 50% Ngora 1 100% 1 100% 2 100% Serere % 2 100% Soroti % 1 50% Teso Region Average 5 100% 10 71% 15 81% SMP Average 28 79% 52 75% 80 77% Average % of Hospitals & HC IVs who conducted Clinical Audits

36 Table 7: Proportion of children under five referred for further management of malaria who are first given pre- referral at HC IIIs & HC IIs Districts No. of HFs IIs and IIIs % of children under five referred for further management of Central Region Buikwe 24 53% Bukomansimbi 14 23% Butambala 17 34% Buvuma 7 0% Gomba 18 33% Kalungu 23 28% Kayunga 20 47% Lwengo 18 41% Masaka 20 25% Mityana 23 33% Mpigi 18 15% Mubende 23 30% Mukono 12 59% Nakasongola 27 45% Rakai 44 30% Sembabule 11 23% Wakiso 17 51% Central Region Average % Hoima Region Buliisa 8 44% Hoima 26 48% Kiboga 15 20% Kiryandongo 18 51% Kyankwanzi 19 42% Masindi 23 34% Hoima Region Average % Teso Region Amuria 17 43% Bukedea 8 27% Kaberamaido 17 70% Katakwi 13 46% Kumi 8 34% Ngora 10 48% Serere 15 80% Soroti 15 46% Teso Region Average % SMP Average % SMP Target 80% malaria who are first given pre- referral treatment at HC II & III

37 Table 8: Percentage of health facilities reporting no ACT stockouts Districts Hospitals & HC IVS Supervised Facilities Supervised (Hosp, HCIvs, HCIII, HC II) Central Region No. of Hosp Ave % of Hosp No. of HC IVs Ave % HC Ivs No. of Hosps & HCIvs Ave % of Hosp & HC Ivs No. of HFs Average % of HFs Buikwe 4 100% % 29 98% Bukomansimbi % 1 100% 16 75% Butambala 1 100% % 19 93% Buvuma % 2 100% 9 89% Gomba % 1 100% 19 96% Kalungu 1 100% 2 83% 3 92% 24 94% Kayunga 1 100% 3 78% 4 89% 20 88% Lwengo % 3 100% 22 83% Masaka 1 100% 2 100% 3 100% 26 99% Mityana 1 100% 3 100% 4 100% 27 95% Mpigi 1 100% 1 100% 2 100% 18 94% Mubende 1 100% 3 67% 4 84% 34 94% Mukono % 1 100% % Nakasongola 1 100% 2 100% 3 100% 31 95% Rakai 2 100% 2 50% 4 75% 47 94% Sembabule % 2 83% 19 96% Wakiso 5 100% 5 87% 10 94% 25 88% Central Average % 33 90% 52 95% % Hoima Region Buliisa % 1 100% 10 93% Hoima 1 100% 3 100% 4 100% 32 90% Kiboga 1 100% 1 100% 6 100% 17 98% Kiryandongo 1 100% % 20 97% Kyankwanzi % 20 90% Masindi 1 100% 2 100% 3 100% 28 90% Hoima Average 4 100% 8 100% % % Teso Region Amuria % 2 83% 18 76% Bukedea % 1 100% 7 86% Kaberamaido 1 100% % 18 85% Katakwi 1 100% 1 100% 2 100% % Kumi 2 100% 1 100% 3 100% 12 89% Ngora 1 0% 1 67% 2 34% 12 67% Serere % 2 100% 17 69% Soroti % 1 100% 16 89% Teso Average 5 75% 9 93% 15 90% % SMP Average 30 92% 50 94% 92 95% %

38 Table 9: Percentage of health facilities with a functional laboratory that has a maintenance log Districts Central Region Hospitals & HC IVS Supervised Facilities Supervised (Hosp, HCIvs, HCIII, HC II) No. of Average No. of Average % No. of Hosp Average % of No. of Average % Hospi % of Hosp HC IVs of HC Ivs & HC Ivs Hosp & HC Ivs HFs of HFs Buikwe 4 50% % 21 48% Bukomansimbi % 1 100% 9 56% Butambala 1 100% % 4 75% Buvuma % 1 100% 3 33% Gomba % 1 100% 6 83% Kalungu 1 100% 2 50% 3 75% 17 41% Kayunga 1 100% 1 100% 2 100% 13 54% Lwengo % 1 100% 14 50% Masaka 2 100% 2 50% 4 75% 15 60% Mityana 1 0% 3 67% 4 34% 20 40% Mpigi 1 100% 1 100% 2 100% % Mubende 1 100% 3 100% 4 100% 12 33% Mukono % 2 50% 13 54% Nakasongola 1 0% 2 100% 3 50% 15 40% Rakai 2 50% 2 50% 4 50% 30 27% Sembabule 0 2 0% 2 0% 7 14% Wakiso 5 40% 5 40% 10 40% 24 33% Central Region Average 20 67% 38 74% 39 72% % Hoima Region Buliisa % 1 100% 7 57% Hoima 1 100% 3 33% 4 67% 23 48% Kiboga 1 100% 1 0% 2 50% 5 80% Kiryandongo 1 100% % 10 50% Kyankwanzi % 1 100% 12 92% Masindi 1 100% 1 0% 2 50% 11 45% Hoima Region Average 5 100% 13 47% 18 78% 68 62% Teso Region Amuria 0 2 0% 2 0% 12 25% Bukedea % 1 100% 9 67% Kaberamaido 1 100% % 12 33% Katakwi 1 100% 1 100% 2 100% 8 75% Kumi 2 100% 1 0% 3 50% 7 29% Ngora 1 100% 1 100% 2 100% 7 57% Serere % 2 100% 10 60% Soroti % 2 100% 13 46% Teso Region Average 5 100% 9 71% 14 81% 78 49% SMP Average 30 89% 60 64% 90 77% %

39 Table 10: Proportion of Hospitals Recording Accurate Data Districts Hospitals & HC IVS Supervised Facilities Supervised (Hosp, HC Ivs, HC III, HC II) Average % No. of Average % No. of Hosp Average % of No. of Average % No. of Hosp of Hosp HC IVs of HC Ivs & HC Ivs Hosp & HC HFs of HFs Central Region Buikwe 4 100% % 21 67% Bukomansimbi % 1 100% 13 62% Butambala 1 100% % 18 89% Buvuma % 2 100% 9 67% Gomba % 1 100% 18 94% Kalungu 1 0% 2 100% 3 50% 21 81% Kayunga 1 100% 3 100% 4 100% 22 86% Lwengo % 2 100% 21 90% Masaka 2 100% 2 100% 4 100% 27 93% Mityana 1 100% 3 67% 4 83% 21 71% Mpigi 1 100% 1 100% 2 100% % Mubende % 3 67% 24 71% Mukono % 1 100% 15 47% Nakasongola 1 100% 2 100% 3 100% 29 76% Rakai 1 0% 2 0% 3 0% 45 80% Sembabule % 2 100% 20 80% Wakiso 3 100% 4 100% 7 100% 22 86% Central Average 16 78% 31 89% 47 88% % Hoima Region Buliisa % 1 100% 10 70% Hoima 1 0% 3 100% 4 50% 31 81% Kiboga 1 100% 1 100% 2 100% 16 94% Kiryandongo 1 100% % 18 72% Kyankwanzi % 1 100% 20 85% Masindi 1 0% 2 100% 3 50% 29 76% Hoima Average 4 50% 8 100% 12 83% % Teso Region Amuria % 2 50% 19 74% Bukedea % 1 100% 10 70% Kaberamaido 1 100% % 18 67% Katakwi 1 100% % 12 58% Kumi 2 0% 1 0% 3 0% 12 42% Ngora 1 100% 1 100% 2 100% 11 73% Serere % 2 50% 14 71% Soroti 0 1 0% 1 0% 14 71% Teso Average 5 75% 8 50% 13 63% % SMP Average 25 68% 47 80% 72 78% %

40 Table 11: Proportion of Health Facilities Analyzing and Utilizing Data for Decision Making Districts Hospitals & HC Ivs Supervised Facilities supervised No. of Hosp Average % No. of Average % No. of Hosp Average % No. of Average % of Hosp HC IVs of HC Ivs & HC IVs of Hosp HFs of HFs Central Region Buikwe 4 100% % 29 41% Bukomansimbi % 1 100% 16 56% Butambala 1 0% 0 1 0% 19 68% Buvuma % 2 100% 9 78% Gomba 0 1 0% 1 0% 19 84% Kalungu 1 0% 2 0% 3 0% 25 16% Kayunga 1 100% 3 67% 4 84% 22 45% Lwengo % 2 100% 22 45% Masaka 2 100% 2 50% 4 75% 26 54% Mityana 1 0% 3 67% 4 34% 28 32% Mpigi 1 100% 1 100% 2 100% 20 80% Mubende 1 0% 3 67% 4 34% 34 32% Mukono % 1 100% 16 56% Nakasongola 1 100% 2 50% 3 75% 32 59% Rakai 1 0% 2 0% 3 0% 45 40% Sembabule % 2 100% 20 55% Wakiso 4 50% 5 100% 9 75% 26 69% Central Average 18 50% 32 67% 50 63% % Hoima Region Buliisa 0 1 0% 1 0% 10 30% Hoima 1 0% 3 100% 4 50% 31 32% Kiboga 1 100% 1 100% 2 100% 17 47% Kiryandongo 1 100% % 20 55% Kyankwanzi % % Masindi 1 100% 2 50% 3 75% 30 40% Hoima Average 4 75% 8 70% 12 65% % Teso Region Amuria % 2 50% 18 33% Bukedea % 1 100% 10 50% Kaberamaido 1 100% % 18 67% Katakwi 1 0% 1 100% 2 50% 13 23% Kumi 2 100% 1 0% 3 50% 11 73% Ngora 1 100% 1 100% 2 100% 12 83% Serere % 2 100% 17 65% Soroti 0 2 0% 2 0% 15 47% Teso Region Average 5 75% 10 64% 15 69% % SMP Average 27 67% 50 67% 77 66% %

41 Table 12: Proportion of Health Facilities that conducted CME during the quarter Districts Hospitals & HC IVS Supervised Facilities Supervised (Hosp, HCIvs, HIII, HC II) No. of Average % of No. of Average % No. of Hosp Average % of No. of Average % of Hosp Hosp HC IVs of HC Ivs & HC Ivs Hosp & HC Ivs HFs HFs Central Region Buikwe 4 100% % 27 93% Bukomansimbi % Butambala 1 100% % 18 89% Buvuma 0 2 0% 2 0% 7 29% Gomba % 1 100% 16 81% Kalungu 1 100% 2 100% 3 100% 23 61% Kayunga 1 100% 3 100% 4 100% 22 64% Lwengo % 3 67% 19 63% Masaka 2 100% 2 50% 4 75% 27 56% Mityana 1 100% 3 67% 4 84% 27 65% Mpigi 1 100% 1 0% 2 50% 20 85% Mubende 1 100% 2 100% 3 100% 30 53% Mukono % 2 100% 16 69% Nakasongola 1 100% 2 100% 3 100% 31 71% Rakai 2 100% 2 100% 4 100% 43 47% Sembabule % 2 100% 18 78% Wakiso 5 100% 5 100% % 26 85% Central Average % 19 77% 30 86% % Hoima Region Buliisa % 1 100% 10 70% Hoima % 3 67% 30 43% Kiboga 1 100% 1 100% 2 100% 17 53% Kiryandongo 1 100% % Kyankwanzi % 1 100% 19 68% Masindi 1 100% 2 100% 3 100% 23 61% Hoima Average 3 100% 8 93% 11 93% % Teso Region Amuria 0 2 0% 2 0% 19 42% Bukedea % 2 100% 9 78% Kaberamaido 1 100% % 18 67% Katakwi 1 100% 1 100% 2 100% 13 69% Kumi 2 100% 1 100% 3 100% 12 75% Ngora 1 100% 1 0% 2 50% 12 33% Serere % 2 50% 15 40% Soroti % 2 50% 16 50% Teso Average 5 100% 11 57% 16 69% %