“I asked her to allocate some money to meals for visitors and she told me that she had already spent it,” the report partly quotes.
“The chairman of the management committee was not aware of the money that the health facility had received. I had to pull out a copy of the guidelines of the roles of HUMC and the in-charge had to surrender Shs 100,000 of the Shs 300,000 she had received. This illustrates how none of the HUMC members knew their mandate.”
Such ineffective governance compromises the ability of management to succeed. For example, most HUMCs had at least two or three members that had dropped out at the time of assessment. The findings also reveal minimal participation of hospital boards in sensitizing the community on health rights, their roles and responsibilities.
Within the framework of the decentralization policy, which Uganda has implemented since 1997, district local government councils are responsible for identifying health priorities and implementing health projects in their districts.
HUMCs and hospital boards oversee the utilization of resources at the health facilities. They also streamline performance of health personnel including ensuring that health workers at health facilities report for work on time, attend to patients promptly and respect the rights of patients as enshrined in the 2009 Patients’ Charter.
Measures recommended by the principal researcher, Dr NarathiusAsingwire, to make HUMCs more responsive include a more participatory procedure that involves users in the election of members of the management committees.
“The health ministry should also conduct periodic appreciative assessments or inquiries on HUMC and hospital boards to increase their effectiveness and efficiency in management of health facilities,” Dr Asingwire noted.
He added that there is need to draw elaborate plans and locally mobilize resources to promote community interface activities to increase transparency and accountability. Also, to increase primary health care financing and encourage civil society support, mainly technical support.
2. Whereas the policy guidelines provide for membership on the committee for not more than two terms of three years each, some members had served on the committee for more than six years, with some having been on the committee since 2006.
3. Two staff representatives on the HUMC is the norm, rather than one as provided in the policy guidelines