The document summarizes the findings of a survey on funding and provision of family planning services in Uganda. It finds that [1] donors provide over 10 times more funding for family planning than the Ugandan government, [2] government spending is only on female-oriented contraceptives, and [3] there are inconsistencies between supply records at health centers and the central level. It recommends that the government increase domestic funding, procure male contraceptives, and improve record-keeping and community awareness of family planning.

1. WHERE IS THE MONEY
FOR
FAMILY PLANNING
SERVICES IN UGANDA?
1
FORUM FOR WOMEN IN DEMOCRACY (FOWODE)

2. WHERE IS THE MONEY FOR
FAMILY PLANNING SERVICES
IN UGANDA
is published by Forum for Women and Democracy
(FOWODE) with support from the Results for
Development (R4D)
© 2012
Forum for Women in Democracy (FOWODE)
P.O. Box 7176, Kampala
Tel: +256-41-286063
E-mail: fowode@fowode.org
Web www.fowode.org
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3. WHERE IS THE MONEY FOR FAMILY PLANNING
SERVICES IN UGANDA?
Forum for Women in Democracy (FOWODE)
conducted a Public Expenditure Tracking Survey
(PETS) of funds/materials allocated to Family
Planning (FP) services right from the Ministry
of Finance Planning and Economic Development
(MFPED) through the Ministry of Health (MoH),
National Medical Stores (NMS) and Health Centers
(HCs) III and IV where family planning services are
accessed by women at the grassroots communities
in five districts of Uganda . The research sought to
answer the following key questions:
1. What are the Family Planning services
provided at the facility level?
2. How are funds/materials transferred from the
central level to the health units
3. What is allocated in the budget for Family
Planning services?
4. Do the money/materials reach the health unit?
What guidelines/mechanisms are in place for
ensuring accountability of funds released for
Family Planning services?
Key issues
• Only UGX 1,846,897,798 was allocated to
Family Planning by the government of Uganda
for the FY 2010/11
• Donors provided US $ 9,657,095, which is over
10 times Uganda government’s funding for
Family Planning commodities.
• Government expenditure on Family Planning
Commodities was on commodities that can
only be used by women; implants, IUDs and
Depo Provera
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4. • Overall, dispensing constituted only 40.0% of
what was actually received by health units.
• 17 out of the 30 surveyed health units lacked
separate cabins for storage of documents.
There was an additional challenge of lack
of qualified records assistants in half of the
Health Centers surveyed.
Health Unit Management Committees (HUMCs)
played no oversight roles in the management of
Family Planning services including participating
in accounting to the District Health Officers and
communities.
Research Findings
1. Financing Family Planning: The study
discovered that donors provided the bulk
of funding for family planning in Uganda.
In FY 2010/11 Only UG shs 1,846,897,798
(equivalent to USD 923,440) was allocated to
Family Planning while donors notably UNFPA,
USAID and DFID spent USD 9,657,095 on
family planning during the same period.
Figure 1: Government Vs Donor funding
towards Family Planning services
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5. Government’s per capita expenditure on family
planning commodities for women of reproductive
age was UG shs 223 of USD 0.09 while Donor’s
per capita expenditure on family planning
commodities for women and men of reproductive
age amounts to USD. 0.56. If the demand for Family
Planning commodities was to rise, US $ 7.4 is the
recommended per capita expenditure.
Government should substantially increase its
allocations for family planning commodities to US
$ 7.4 per capita.
Government expenditure on Family Planning was
on commodities that can only be used by women;
implants, IUDs and Depo Provera.
Figure 2: Government expenditure on Family
Planning Commodities.
Government should also procure family planning
commodities used by men, especially condoms.
2. Family Planning Services Offered at Health
Units: Family planning services (commodities
and requisite surgery where necessary)
provided at health facility level differ by level
of facility, personnel and equipment available
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6. at the facility. For example, IUDs and implants
are not provided at Health Center IIIs Miriam
disputes this. These services are provided at
Health Center IVs which should ideally have a
medical doctor and a theater. However, not all
health centre IVs have medical doctors and/
or theaters. Of the 10 surveyed Health Centre
IVs, only 4 (Kakindo in Kibaale, Awach in Gulu,
Nyimbwa and Luwero both in Luwero district)
had doctors. Health Center IVs lacking doctors
can therefore not provide services like IUDs
and implants.
All Center IVs should have skilled medical
personnel and surgical equipments required
for family planning services.
Planning Commodities. Whereas the
3. Tools for Delivery and Receipt of Family
NMS and health units utilize the tools for
delivery and receipt of family planning
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7. commodities, respectively, there is still
room for improvement. The survey revealed
discrepancies in the records of supplies both
at the National Medical Stores and several
health units for most health centers. First,
NMS delivery notes are written in Entebbe
with details of dates, types and quantities of
FP commodities to be delivered to each health
unit. Ideally, health units ought to sign the
delivery notes upon verifying the types and
quantities actually delivered. But in several
cases, the delivery forms are signed when the
quantities indicated as delivered are less or
more than what is written on the NMS delivery
forms. In other words, in several cases, health
units’ countersigning of delivery notes is
perfunctory. See examples in the table below:
Period District National Health Center Received records
Medical Stores
Delivery records
Muko Health Commodities worth Commodities worth
Center IV, Kabale US $ 2,677.6 were US $ 6,891.05 were received.
FY delivered
2010/11
Kamukira Health Commodities worth Commodities worth only
Center IV, Kabale US $ 5,800.805 US $ 1,545.355 were received
were delivered
Nabuli Health Commodities worth Commodities worth only US $ 499
Center III, Kibuku US $ 745.5 were were received
delivered to
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8. There was a general lack of qualified record
3.1 Lack of qualified Records Assistants:
assistants in over half of the health centers
surveyed. Records were in some units
made by midwives because family planning
commodities were associated with maternal
health, but some are overwhelmed with
numbers of expectant mothers to attend to;
hence no time to even record in-coming and
dispensed commodities. In other cases, staff
tasked with making entries into stock cards
could not distinguish between different types
of commodities. For example in Zirobwe
Health Center III, it was observed that the
stores and records assistant always failed
to distinguish between Levonorogestrel
0.03mg 3 cycle commodities in the blue
packets and other packed in red packets.
Stock cards for the two commodities were
not properly prepared and no meaningful
information could be extracted from the
stock cards during this survey.
Qualified records assistants should be recruited in
Health Centers.
3.2 Data processing was also a problem in all
health units due to break down of their
computers which were not regularly
serviced and/or sufficiently protected from
viruses. In addition, costs of photocopying
monthly report forms and stock cards were
prohibitive to most health units which did not
have electricity and had to travel miles to do
so. Intermittent electricity supplies further
increased costs of photocopying because
the photocopying business entities had to
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9. rely on generators. Transport for delivering
reports to the District Health Officers was
also a problem since all health units lacked
transport facilities. In the rural areas, Health
Center staff had to hire bicycles out of the
already meager non wage PHC grant. Since
the transport line item was not catered for,
this delayed delivering accountability reports
to the District Health Officers.
Health Centers should also be equipped with
functional data storage and processing equipment
especially computers with adequate funding for
servicing and virus protection.
3.3 Record Keeping Facilities: 17 out of the
30 surveyed health units had poor storage
facilities for general medical drugs and
Family Planning commodities. Storage space
was small, lacked shelves and cupboards
such that some commodities and drugs
were kept on the floor, on top of each other
and/or in boxes which according to the in-
charges, made it difficult to retrieve the
drugs/commodities. Nabuli Health Center
III had only 2 delivery notes and all records
were kept at the midwife’s home, hence very
susceptible to loss.
Health Centers should be availed records keeping
facilities notably filing cabinets.
4. Transfer of Funds/Materials From
The survey revealed that the supply of
the Central Level to the Health Units:
Family Planning commodities to Health
Centers by the National Medical Stores
was not streamlined. There were cases of
infrequent deliveries to health units that
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10. were not based on availability of surplus
commodities from previous deliveries but on
inaccessibility (hard to reach) of health units,
misinformation about closure of some health
units and misallocations by the National
Medical Stores, whereby some health units
received more than was recorded by the
National Medical Stores while other units
received less than was recorded by the
National Medical Stores.
National Medical Stores should streamline
the supply of Family Planning commodities
to the Health Centers for proper records and
accountability.
5. Dispensing of family planning
Overall, dispensing constituted only 40.0%
commodities at the Health Centers:
of what was actually received by health
units. In some Health Centers for example
Bulangila Health Center III, in Kibuku
District, dispensing constituted only 11.3%.
In Kamwezi Health Center IV in Kabale,
District, it was 28.8%. Nonetheless, all was
not grim since Bukinda Health Center III
dispensed all the commodities it received,
Kamukira Health Center IV also in Kabale
District dispensed 83.8% and Kyanamira
Health Center III also in Kabale District
dispensed 76.4%.
Given the low dispensing levels of FP commodities,
it is evident that the accountability to communities
is not effective. Deliberate efforts should be made
to intensify accountability to communities through
sustained IEC campaigns. Targeting males is also
recommended because most males do not visit
health units and do not attend community health
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11. outreaches as much as women do. Hence, health
unit/health outreach settings for dissemination of
family planning IEC do exclude males.
Health Unit Management Committees.
All health units with the exception of Awach
Health Center IV in Gulu district had Health
Unit Management Committees. All Health Unit
Management Committees were male dominated
and instead of meeting quarterly, 3 had not met at
all during FY 2010/2011, citing lack of funds while
19 met once or twice during the FY. In addition,
none of the minutes of the meetings seen by the
research team had ever had Family Planning on
its agenda. Besides sometimes verifying the types
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12. and quantities of Family Planning commodities
delivered, Health Unit Management Committees
played no oversight roles in the management of
Family Planning services including participating
in accounting to the District Health Officers and
communities.
The roles of Health Unit Management Committees
in accounting to the District Health Officers and
communities should be strengthened.
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13. The following recommendations are made:
AREA RECOMMENDATION
ASSESSED
Financing Government should substantially
Family increase its allocations for family
Planning: planning commodities to US $ 7.4
per capita.
Government should also procure
family planning commodities
used by men, especially condoms
because implants, IUDs and
Depo Provera that Government
expenditure on family planning
services procures are commodities
that can only be used by women.
Donors should increase per capita
spending on Family Planning
commodities to US $ 7.4
Supply Records of the National Medical
of family Stores supplies of Family Planning
planning commodities to Health centers
commodities need to be streamlined to minimize
inconsistencies in both National
Medical Stores and health center
supplies and delivery records.
Community Demand for Family Planning
awareness commodities amongst
and communities should be enhanced
utilization through strategies that cover non
of family health unit/health outreach settings
planning such as community social and
commodities economic settings for example
markets, agricultural advisory
services’ meetings, community
halls or even clubs and bars where
males are more likely to be found.
Family planning IEC could also
be packaged and delivered in
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14. AREA RECOMMENDATION
ASSESSED
Community economic and social terms such as
awareness linkages between family planning
and adoption and economic productivity,
utilization financial savings, a planned life
of family and a more physically vibrant wife,
planning children and family as a whole.
commodities
In the short run, some funds
for procuring Family Planning
commodities could be diverted
from procuring the commodities
to conducting IEC campaigns
for Family Planning utilization
within communities. Once demand
increases, the funds could be
re-channeled back to purchasing
Family Planning commodities
Record Qualified records assistants should
Keeping: be recruited in health centers
Health centers should be availed
with data storage and processing
facilities especially computers with
adequate funding for servicing and
virus protection
Funding for stationery,
photocopying and transport to
District Health Offices should
be availed to reduce delays in
forwarding accountability reports
Management The roles of HUMCs in accounting
of family to the District Health Officers
planning and communities should be
services: strengthened.
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15. Conclusion
One way of improving safe motherhood indicators
in Uganda is ensuring that family planning services
are accessible and utilised. Family planning is one
of the key priority areas of funding for the Ministry
of Health (MoH) under its Reproduction Health
Division. We therefore call upon the Government
of Uganda to increase funding towards family
planning services.
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16. VISION:
A just and fair society where women and
men equally participate in and benefit from
decision making process
MISSION:
Promoting gender equality in all areas of
decision making through advocacy, training,
research and publications.
Forum for Women in Democracy
(FOWODE)
P O BOX 7176, Kampala
Tel: + (256) 041 4 286063
Email: fowode@utlonline.co.ug
Email: fowode@fowode.org
Web: www.fowode.org
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Where is the money for family
planning services in uganda
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