Challenges faced by Health Unit Management Committees in rendering Health Services to Communities in East-central Uganda.

Abstract

Like other countries, Uganda implements programs that help to enhance health services delivery in communities. One of the strategies to ensure this is by facilitating the construction of health centres and equipping them with adequate staff including doctors, nurses and Health Unit Management Committees (HUMCs), who are the basis for this study. However, it has been established that much as HUMCs monitor the general administration of the HCIII on behalf of the Local Council and the Ministry of Local Government, done within the policy and guidelines of Ministry of Health, the environment under which they work is characterized by a number of challenges which affect the effectiveness of HUMCs services. The study was largely qualitative and only interviews were used to obtain responses from HUMCs and a few administrators. Purposive sampling technique was largely used to select the sample size of 288 respondents who were predominantly HUMcs. The challenges are multiple. Results were analyzed qualitatively. Where necessary and to a small extent, verbatim forms were used to report the original voices of HUMCs. First, HUMCs do not participate in most of the meetings even those concerning events at health centres. This limits endeavors for transparency and accountability. In addition, rewards system at health centres rarely caters for the HUMCs who are tasked with the duty to monitor all activities. This reduces the morale of HUMCs to work hard because they do not feel part of the working team at HUMCs. Another great challenge was on the lack of proper coordination between HUMCs at health centres and district health teams (DHTs) which has resulted in the design of rewards systems not catering for HUMCs. Conclusively, a number of challenges including lack of adequate training, low participation in meetings and lack of seminars as well as workshops to intimate them with various tasks of their work characterized delivery of health services to communities by HUMCs. At the moment, the HUMCs are tasked to oversee many responsibilities but are rarely appreciated, salaries come late, and the chances to have a say in the vertical planning system are minimal. Therefore, the HUMCs are not as effective as expected due to the numerous challenges they face. The key recommendation was that members of HUMCs should be trained for at least 2 weeks by a group of well-drilled mentors and the training should be hands-on (mentorship). This will enable them to appreciate the role, tasks and challenges and participate in improving services. It is also recommended that MoH trains a pool of mentors at least 10 per district to be able to train all the members of HUMC in each district