Institutional Capacity Assessment of the aids control Program Uganda
Procurement, distribution, Stock and inventory management
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- 3.12 Quality control for critical drugs, equipment and supplies
- 3.13 Monitoring and evaluation
- 3.14 Management information systems
- 3.15 Adequacy of physical infrastructure
- Major Themes and Recommendations
- 4.2 Appropriateness of ACP organizational governance structure in relation to its mandate
- Annexes
3.11 Procurement, distribution, Stock and inventory managementThis study assessed ACP’s capacity as it relates to procurement, distribution, stock and inventory management. Questions covered the compliance with appropriate procurement laws in purchases and award of contracts, procurement practices, systems for stocking and distribution as well as donor financing for drugs and supplies. Participants scores and discussion in this domain is presented below Individual % score range: 31 - 75 Group consensus score: 55% Table 14: Procurement, Distribution, Stock & Inventory Managment
A consensus score of 55% shows that ACP is systematically achieving in this domain. The main reasons given to justify this score are ACP’s observance of guidelines on public procurement and disposal of assets (PPDA), and good record system for tracking procurement and supplies. However current weaknesses identified with the procurement and distribution system include the existence of parallel systems for drugs and supplies contributed by development partners as well as lack of coordination of the various systems which has resulted in inefficiencies and wastage. Participants pointed to frequent stock-outs, bureaucracy at the stores and stock piles of expired drugs as evidence of the weaknesses in the system. Furthermore, it does appear that institutional roles in relation to the selection, quantification and procurement of drugs and other supplies may not be very clear amongst key bodies involved. It is recommended that roles clarification be done as a component of targeted institutional capacity building effort for the relevant institutions or as a separate task by its self. 3.12 Quality control for critical drugs, equipment and suppliesThis study was also interested in learning about the capacity of ACP in terms of its role in ensuring that high quality and effective drugs, equipment and supplies are used for the care of HIV infected people in the country. Participants were asked questions about existence of quality standards and quality assurance practices as it relates to HIV medicines, policies on selection of essential drugs, and equipment supplies. The scores and discussions are presented below: Individual % score range: 47 - 80 Group consensus score: 60% Table 15: Quality control of critical drugs, equipment and supplies
Even though participants reached a consensus score of 60%, some participants indicated that they were not familiar with the issue of drugs and what ACP’s role should be. Nevertheless, some of the reasons why ACP is thought to merit this score include the existence of public institutions responsible for setting and enforcing drugs and equipment standards, and existence of a mechanism for recall of problematic drugs. Interestingly, it does not appear that ACP is relating with the mentioned institutions in any discernable way. On the down side, participants identified non inclusion of maintenance plan and non consideration of local maintenance capacity when equipment are being donated or procured, non- enforcement of quality standards for donated equipment and procurement/donations process which does not factor in feedback from end-users. Since ACP does not handle drugs and equipment quality directly, it is important to clarify the role of ACP in drugs and equipment selection and for ACP to ensure that feedback from end users are communicated to appropriate agencies. 3.13 Monitoring and evaluationIn this domain, ACP’s capacity was assessed in terms of its understanding and performance of the role of monitoring the national health sector response. Specific questions covered include, the existence and adequacy of systems for monitoring and supervision of the health sector response, adequacy of skilled staff for M&E, acquaintance of M&E staff with national M&E framework, use of nationally prescribed tools in the M&E framework for routine monitoring of health sector response and reflection of appropriate HIV/AIDS indicators in national surveys such as house hold income and expenditure surveys, NDHS etc. The scoring and discussions are presented below: Individual % score range: 30 - 67 Group consensus score: 45% Table 16: Monitoring & Evaluation
3.14 Management information systemsFor the information system domain, this study sort to know ACP capacity in terms of its ability to develop a good information system for HIV/AIDS generally and ACP specific activities in particular, the quality of data collected, feedback mechanisms, use of data for decision making as well as accessibility and usefulness of information to stakeholders. The scores and group discussions are presented below; Individual % score range: 31 - 62 Group consensus score: 50% Table 17: Management Information systems
Participants reached a consensus score of 50% for ACP capacity in information systems. Some of indicators of what is going well in this domain are the growing relationship between ACP and the Resource centre which manages the Health management Information System (HMIS). Currently there is a medical doctor at the Resource center charged with the responsibility of overseeing HIV-related data systems. However, it was also noted that ACP is limited in its capacity to prepare and share information in a timely manner. Delays in the transmission of reports from the periphery and limited use of information sharing media such as the internet are blamed for this limitation. Referring to the internet issue, participants noted quite mockingly that the ACP website ‘is always under construction’. It was also pointed out that an opportunity currently exist to increase the use of data for decision making as there is a rising demand for HMIS data by different stakeholders. ACP needs to develop an information system that links all its projects and feeds into the national HMIS. 3.15 Adequacy of physical infrastructureUnder the domain of physical infrastructure, ACP capacity was assessed in terms of adequacy of office accommodation and spatial environment, adequacy of office equipment, availability of needed supplies and furniture, capital planning for new acquisitions, maintenance of building and equipment, recording and control of fixed assets and availability of vehicles for coordination. The score and discussions are presented below Individual % score range: 24 - 52 Group consensus score: 50% Table 18: Adequacy of physical infrastructure
4.1 Understanding and Implementation of ACP mandate by staff membersThe overall role of the ACP is to support the ministry of health to implement its 5 main mandates which include, policy formulation, setting technical standards & quality assurance, resource mobilization, capacity development & technical support, and coordination of services. As earlier stated, this major roles are translated into specific tasks in the HSHASP and these include, coordination of all the program areas; ensure implementation of HIV/AIDS activities; resource mobilization/utilization and accountabilities; promote staff development; and mitigate the effects of HIV/AIDS in workplace settings such as health facilities and offices. There is a mixed picture on the understanding and implementation of ACP mandate by staff members. Responses from the FGD indicate that certain key functions such as policy formulation, setting technical standards and disease monitoring appear to be well understood and implemented as the traditional core function of the ACP. Other functions such as sectorial response planning, HIV mainstreaming and resource mobilization seem to be much less understood and implemented. For most of these responsibility areas, no staff members are assigned and few guidelines exist. Responses from the survey of MOH staff perceptions of different ACP functions suggest that a significant proportion of respondents belief that ACP is not effective in the Coordination function. From the survey, 60% of respondents disagreed with the statement that coordination of the response between ACP and districts is effective; 41% disagreed or strongly disagreed with the statement that internal coordination within MOH is effective. Together with this, a review of current projects overseen or implemented in collaboration with ACP indicate that ACP devotes a disproportionate level of effort to direct service related responsibilities at the detriment of technical management and oversight function. Knowledge gap and portfolio review as well as a reorientation are recommended. 4.2 Appropriateness of ACP organizational & governance structure in relation to its mandateOne important question in this study is whether ACP as currently organized is appropriate for its mandate. A related question is whether the position of ACP is appropriate in the Ministry of health. In order to answer this question, responses from the Governance and Leadership; Structure, roles & responsibilities; and Human resources sections, were further reviewed alongside two ACP organograms that were provided in the course of the study. From the study findings, ACP as currently organized will be severely limited in its ability to fully carry out its mandate. Firstly, in terms of the organizational structure, there are two separate organograms which show a total of 71 positions for staff members employed by government as well as those seconded through partner supported projects (especially the CDC projects). Even though the organogram with the project based staff members show an obscure link to the base ACP organogram, the two are not harmonized and lines of communication are not always very clear. Re-affirming this, respondents in the FGD reported unclear communication and reporting lines as one of the confusing things in the current structure. An example we reported earlier; that many ACP staff tended to regard the ACP manager as their direct supervisors even when they have direct supervisors, is pertinent here. Similarly respondents from the FGD also indicate that not all positions are captured in the organogram. Hence even though total number of staff members was reported at the FGD to be more than 100, only 71 positions are captured in the combined organogram.. Additionally, the units and position titles in the current set of organogram, are prone to some overlap and inefficiencies while certain functions are totally lacking. In line with earlier recommendations therefore, a thorough revision of the organogram should be done as a matter of priority. This should include an analysis and description of each job position in ACP and the development of a revised and harmonized organogram. This activity should produce an idea of the staffing norm for the ACP and inform other recommendations in terms of appropriate number and mix of staff. In terms of the relative position of ACP within the ministry of health, it is recommended that a ACP management be granted the necessary authority (including financial) to manage the health sector response and make. One way to achieve this is to engage policy makers within the ministry of health to address the issue. AnnexesDownload 191.49 Kb. Share with your friends:
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