INTERGRATED SUPPORT SUPERVISION REPORT YEAR 3, QUARTER 4. December P age

INTERGRATED SUPPORT SUPERVISION REPORT YEAR 3, QUARTER 4 December 2011 1 P age

Plot 30B Impala Avenue, Kololo (near Nanjing Restaurant) P.O Box 37718, Kampala Tel: +256-312-600600 Fax: +256-312-600609 Stop Malaria Project is a five-year program (2008-2013) funded by the Presidential Malaria Initiative (PMI) and the United States Agency for International Development (USAID). The project is managed by Johns Hopkins University Bloomberg School of Public Health, Center for Communication Programs (JHU/CCP) and implemented in collaboration Malaria Consortium, the Infectious Disease Institute (IDI), and Communication for Development Foundation Uganda (CDFU). 2 P age

Table of Contents List of Acronyms... 4 1.0 STOP MALARIA PROJECT... 5 1.1 Integrated Support Supervision... 5 2.0 PERFORMANCE OF HEALTH FACILITIES VISITED DURING SUPPORT SUPERVISION... 6 2.1 MALARIA IN PREGNANCY... 7 2.1.1 Uptake of two doses of by mothers during ANC Visits... 7 2.1.2 Health Facilities offering IPT p under DOTs... 9 2.1.3 Status of SP... 9 2.1.4 Health Facilities at least 2 ANC Health Workers Oriented in Quality Improvement Approach... 10 2.1.5 ANC Clinics distributing LLINs... 12 2.1.6 Health Educational Talks about Malaria during ANC Clinics... 12 2.2 Case Management... 14 2.2.1 Referral of Emergency Cases... 14 2.2.2 Status of Stock out... 15 2.3 Laboratory Diagnosis... 16 2.3.1 Mainten Log... 16 2.3.2 Availability of Laboratory Personnel... 17 2.3.3 Availability of Testing Protocols... 18 2.4 Behaviour Change Communication and Community Mobilization... 18 2.4.1 Health Facilities Displaying Malaria IEC Materials on Walls... 18 2.4.2 Health Facilities BCC Materials... 20 2.4.3 Health Facilities Health Assistants Attached... 20 2.5 Support Supervision... 21 2.5.1 Support Supervision from Upper Levels... 21 2.6 Health Management Information System (HMIS)... 21 2.6.1 Health Facilities Analyzing and Utilizing Data for Decision Making... 21 2.6.2 Health Facilities Recording Accurate Data... 22 Appendix... 25 Table 1: Criteria for Ranking in SMP Supported Districts... 25 3 P age

List of Acronyms Artemisinin- based Combination Therapy ANC Antenatal Care BCC Behaviour Change Communication CCP Johns Hopkins Bloomberg School of Public Health Center for Communication Programs CDFU Communication for Development Foundation Uganda DHI District Health Inspector DHO District Health Officer DHT District Health Team DOTs Directly Observed Treatment HA Health Assistants HF HSD Health Sub District HMIS Health Management Information Systems IDI Infectious Diseases Institute IEC Information, Education and Communication Intermittent Preventive Treatment in pregnancy ISS Integrated Support Supervision JHU Johns Hopkins University Bloomberg School of Public Health LLIN Long Lasting Insecticide Treated Net MC Malaria Consortium MoH Ministry of Health NMCP National Malaria Control Program NMS National Medical Stores PMI President s Malaria Initiative PNFP Private Not for Profit QI Quality Improvement RDT Rapid Diagnostic Testing SMP Stop Malaria Project SP Sulfadoxine- pyrimethamine ToT Training of Trainers UHMG Uganda Health Marketing Group USAID United States Agency for International Development 4 P age

1.0 STOP MALARIA PROJECT The Stop Malaria Project (SMP) is a five- year program (2008-2013) of development assist that is 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. During the five years, the project endeavours to reach 85% coverage of children under five years of age and in the project area districts proven preventive and therapeutic interventions: 1. Artemesinin- based Combination Therapy () for treatment of uncomplicated malaria 2. Intermittent Presumptive Treatment () 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 of malaria activities. 1.1 Integrated Support Supervision The Stop Malaria Project has continued to provide 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. The purpose of the support supervision is to assess the capacity and gaps of selected health 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 perform gaps, specific action plans to address the gaps are developed the health facility staff. SMP has continued to assess the in the area of ANC/ services, case management, laboratory diagnosis, drug verification, HMIS systems, IEC verification and support supervision to lower health. In the month of September 2011, SMP carried out Quarter 4 support supervision exercises in 535 health in 27 districts. 5 P age

2.0 PERFORMANCE OF HEALTH FACILITIES VISITED DURING SUPPORT SUPERVISION SMP developed criteria against which hospitals and HC IVs perform is measured in this report. SMP will keenly follow up during support supervisi hospitals and HC IVs se perform is below the benchmarks. This will create an opportunity to single out health that require more support and effort to improve their perform. Characteristics of Supervised Health Facilities During support supervision, the Stop Malaria Project trained district supervisors in each district are comprised of a district malaria focal person, the HMIS focal person, laboratory technicians and other district health team members. One or two SMP staff members technically support the team. The team spends time in each health facility observing, interviewing, and providing onsite mentorship to health workers in ANC, case management, laboratory diagnosis, HMIS strengthening, and behaviour change communication. The table below shows characteristics of supervised health by 68% Hospitals, 74% HC IVs, 67% HC IIIs and 32 HC IIs out of the total health in SMP districts. District HC II HC III HC IV Hospital Central Region Bukomansimbi 2 10 1 0 Butambala 11 7 0 1 Kalungu 6 9 2 1 Lwego 4 6 2 0 Masaka 15 8 1 1 Mpigi 5 18 1 1 Nakaseke 9 5 3 2 Nakasongola 20 10 2 1 Rakai 33 19 1 2 Wakiso 1 36 7 4 Central Region Total 106 128 20 13 Hoima Region Buliisa 8 1 1 0 Hoima 14 22 3 1 Kibaale 7 21 4 1 Kiboga 10 5 1 1 Kiryandongo 11 8 0 1 Kyankwazi 10 7 1 0 Masindi 21 10 0 1 Hoima Region Total 81 74 10 5 Teso Region Amuria 2 10 2 0 Bukedea 4 5 1 0 Kaberamaido 5 8 1 1 6 P age

HC II HC III HC IV Hospital Kumi 7 5 1 2 Katakwi 2 6 1 1 Serere 3 9 1 0 Soroti 0 8 2 0 Ngora 3 6 1 1 Teso Region Total 26 57 10 5 Grand Total 213 259 40 23 2.1 MALARIA IN PREGNANCY The Stop Malaria Project targets for LLIN distribution and 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. The MOH policy recommends to take at least two doses of fansidar to help prevent getting malaria in pregnancy. 2.1.1 Uptake of two doses of by mothers during ANC Visits District HC IVs Hospitals District No. of No. of No. Pregnant HC Pregnant Women Hospitals Pregnant of Women IVs 2 2 HFs 2 (Hospital and HC IV) Central Region Bukomansimbi 1 52% 0 NA 1 52% Butambala 0 NA 1 13% 1 13% Kalungu 1 68% 2 21% 3 44% Lwego 2 26% 0 2 26% Masaka 1 42% 1 95% 2 69% Mpigi 1 47% 1 69% 2 58% Nakaseke 3 17% 2 55% 5 36% Nakasongola 2 49% 1 33% 3 41% Rakai 1 13% 2 69% 3 41% Wakiso 7 36% 4 48% 11 42% Central Region Hoima Region 19 39% 14 50% 33 42% Buliisa 1 77% 0 NA 1 77% Hoima 3 42% 1 28% 4 35% Kibaale 4 47% 1 47% 5 47% Kiboga 1 73% 1 72% 2 72% Kiryandongo 0 NA 1 37% 1 37% Kyankwazi 1 45% 0 NA 1 45% Masindi 0 1 61% 1 61% 7 P age

Hoima Region 10 56% 5 49% 15 53% Teso Region Amuria 2 58% 0 NA 2 58% Bukedea 1 47% 0 NA 1 47% Kaberamaido 1 44% 1 70% 2 57% Katakwi 1 53% 1 133% 2 93% Kumi 1 81% 2 56% 3 68% Ngora 1 87% 1 2 87% Serere 1 52% 0 NA 1 52% Soroti 2 72% 0 NA 2 72% Teso Region 10 62% 5 86% 15 67% SMP 39 52% 24 62% 63 54% To protect mothers and their unborn babies from malaria, SMP continues to promote the uptake of at least two doses of by the mothers during their visit to the ANC clinics. A target of 60%, proportion of the new ANC taking at least two doses of set as a benchmark for measuring perform in each of the health. According to the results in the table above, Teso region (67%) had the highest proportion of both hospitals and HC IVs receiving 2. While the Central region districts had the lowest proportion (42%). Katakwi district (93%) had the highest proportion of taking 2 doses at the hospitals and HC IVs, while Butambala district (13%) had the lowest proportion. According to the overall support supervision findings in all including HC IIIs and HC IIs (Appendix: Table 1) all regions performed below the target (Teso 59%, Hoima 48%, Central 45% and SMP average 50%). The only districts which performed above the target of 60% are all in the Teso Region and these Ngora (79%), Katakwi (71%), and Kumi (62%). Lwengo (29%), Bukomansimbi (37%), Butambala (39%), Mpigi (38%), Kiboga (38), and Kyankwazi (35%) are the worst performing districts. SMP will focus more attention in improving the uptake of IPTP 2 in the central region districts that have performed poorly according to the findings. Ensuring uptake of continues to be a challenge to health because of absence of midwives, fear of SP side effects by the mothers, SP, and late ANC attend by as reported by the ANC health worker. Communication is being used to help overcome these challenges including continuous radio messaging and distribution of IEC and job aids to health to assist health workers when they are conducting health education the mothers. SMP has also continued to run the Stop Malaria in Your Community mass media campaign which also has messages encouraging to take at least two doses of, as well as addressing their associated fears regarding. 8 P age

2.1.2 Health Facilities offering IPT p under DOTs 100% 91% 91% 92% 91% 80% 60% 40% 20% 0% HC II HC III HC IV Hospital Over 90 all the visited which offer do so under the direct observation of the mothers ( DOTS). However, a number of hospitals and HC IVs did not do so during the months of May, June and July due to SP s and these included Lwala Hospital in Kaberamaido, and Ndejje HC IV in Wakiso. Kaweweeta HC IV in Nakaseke did not offer under DOTS due to lack of a midwife at the facility. 2.1.3 Status of SP Stock Outs District HC IVs Hospitals District No. of HC IVs % of no SP No. of Hospitals % of no SP No. of HFs % of no SP Central Region Bukomansimbi 1 100% 0 1 100% Butambala 0 1 100% 1 100% Kalungu 1 100% 2 100% 3 100% Lwego 2 50% 0 2 50% Masaka 1 100% 1 100% 2 100% Mpigi 1 100% 1 100% 2 100% Nakaseke 3 67% 2 100% 5 83% Nakasongola 2 100% 1 100% 3 100% Rakai 1 100% 2 100% 3 100% Wakiso 7 43% 4 100% 11 71% Central Region 19 84% 14 100% 33 90% Hoima Region Buliisa 1 100% 0 1 100% Hoima 3 100% 1 100% 4 100% Kibaale 4 100% 1 100% 5 100% Kiboga 1 100% 1 100% 2 100% Kiryandongo 0 1 100% 1 100% Kyankwazi 1 100% 0 1 100% Masindi 0 1 100% 1 100% 9 P age

Hoima Region 10 100% 5 100% 15 100% Teso Region Amuria 2 100% 0 2 100% Bukedea 1 100% 0 1 100% Kaberamaido 1 100% 1 0% 2 50% Katakwi 1 100% 1 100% 2 100% Kumi 1 100% 2 100% 3 100% Ngora 1 100% 1 2 100% Serere 1 100% 0 1 100% Soroti 2 100% 0 2 100% Teso Region 10 100% 5 67% 15 94% SMP 39 95% 24 89% 63 95% Uptake of highly depends availability of SP in the ANC clinics, and thus SMP tracks the availability of s to ensure timely interventions in the event of. Results in the table above, show 95 the hospitals and HC IVs reported no of SP during the months of May, June and July 2011. Hospitals and HC IVs which reported s include; Lwala Hospital in Kaberamaido, Gwatoro Nursing Home, Wagagai HC IV, Kasangati HC IV, and Ndejje HC IV in Wakiso district, and Kiwangala HC IV in Lwengo district. Most of these are private not for profit (PNFP), therefore, SMP will work PNFPs to ensure proper quantification of SP. In addition, SMP will continue to liaise the different DHTs and SURE project to address the issue of SP. 2.1.4 Health Facilities at least 2 ANC Health Workers Oriented in Quality Improvement Approach District HC IVs Hospitals District No. of HC IVs No. of Hospitals No. of HFs Central Region Percentage of health at least 2 ANC health workers oriented in Quality improvement approach. Percentage of health at least 2 ANC health workers oriented in Quality improvement approach. Percentage of health at least 2 ANC health workers oriented in Quality improvement approach. Bukomansimbi 1 100% 0 1 100% Butambala 0 1 100% 1 100% Kalungu 2 100% 1 100% 3 100% Lwego 2 100% 0 2 100% Masaka 1 100% 1 100% 2 100% Mpigi 1 100% 1 100% 2 100% Nakaseke 3 67% 2 100% 5 83% Nakasongola 2 100% 1 100% 3 100% Rakai 1 100% 2 100% 3 100% Wakiso 7 100% 4 100% 11 100% Central Region 20 96% 13 100% 33 98% Hoima Region Buliisa 1 100% 0 1 100% Hoima 3 100% 1 100% 4 100% Kibaale 4 100% 1 100% 5 100% Kiboga 1 100% 1 100% 2 100% Kiryandongo 0 1 100% 1 100% 10 P age

HC IVs Hospitals District No. of HC IVs No. of Hospitals No. of HFs Percentage of health at least 2 ANC health workers oriented in Quality improvement approach. Percentage of health at least 2 ANC health workers oriented in Quality improvement approach. Percentage of health at least 2 ANC health workers oriented in Quality improvement approach. Kyankwazi 1 100% 0 1 100% Masindi 0 1 100% 1 100% Hoima Region 10 100% 5 100% 15 100% Teso Region Amuria 2 100% 0 2 100% Bukedea 1 100% 0 1 100% Kaberamaido 1 100% 1 100% 2 100% Katakwi 1 100% 1 100% 2 100% Kumi 1 100% 2 100% 3 100% Ngora 1 100% 1 100% Serere 1 100% 0 1 100% Soroti 2 100% 0 2 100% Teso Region 10 100% 4 100% 14 100% SMP 40 99% 22 100% 62 99% To ensure provision of quality services to, in Year 3 SMP supported districts to orient at least two ANC health workers in quality improvement approach in each of the hospitals and HC IVs supported. As a perform measure, each hospital and health centre IV is supposed to have at least two ANC health workers trained in quality improvement approach. The ISS results in the table above reveal that nearly all HC IVs and hospitals (99%) have at least two ANC health workers trained in the quality improvement approach. Kaweweeta HC IV in Nakaseke district currently does not have a midwife attached to it, thus ANC services are unavailable. In the next quarter, SMP will liaise the Nakaseke DHT and the management of health facility to find a solution to this problem. 11 P age

2.1.5 ANC Clinics distributing LLINs 120% 100% 92% 96% 95% 100% 95% 80% 60% 40% 20% 0% HC II HC III HC IV Hospital SMP All hospitals, 95 HC IVs, 96 HC IIIs, and 92 HC IIs are offering ANC services and distributed LLINs during the months of May, June and July 2011. HC IVs which did not distribute LLINs in the three months Kiwangala in Lwengo District, Kaweweeta, in Nakaseke District, and Gwatiro Nursing Home in Wakiso District. 2.1.6 Health Educational Talks about Malaria during ANC Clinics District HC IVs Hospitals District No. of No. of No. of HC IVs giving Hospitals giving HFs giving Talks Talks Talks Central Region Bukomansimbi 1 100% 0 1 100% Butambala 0 1 100% 1 100% Kalungu 1 100% 2 100% 3 100% Lwego 2 50% 0 2 50% Masaka 1 100% 1 100% 2 100% Mpigi 1 100% 1 100% 2 100% Nakaseke 3 0% 2 100% 5 50% Nakasongola 2 100% 1 100% 3 100% Rakai 1 100% 2 100% 3 100% Wakiso 7 100% 4 100% 11 100% Central Region 19 83% 14 100% 33 90% Hoima Region Buliisa 1 100% 0 1 100% Hoima 3 100% 1 0% 4 50% Kibaale 4 50% 1 100% 5 75% Kiboga 1 100% 1 100% 2 100% Kiryandongo 0 1 100% 1 100% Kyankwazi 1 100% 0 1 100% Masindi 0 1 100% 1 100% Hoima Region 10 90% 5 80% 15 89% 12 P age

HC IVs Hospitals District No. of No. of No. of HC IVs giving Hospitals giving HFs giving Talks Talks Talks Teso Region Amuria 2 100% 0 2 100% Bukedea 1 100% 0 1 100% Kaberamaido 1 100% 1 100% 2 100% Katakwi 1 100% 1 100% 2 100% Kumi 1 100% 2 100% 3 100% Ngora 1 100% 1 2 100% Serere 1 100% 0 1 100% Soroti 2 100% 0 2 100% Teso Region 10 100% 5 100% 15 100% SMP 39 91% 24 93% 63 93% During the ANC visits by to the health, the health workers are supposed to conduct health education / sessions about malaria the mothers to ensure that they know the import of sleeping under a mosquito net and taking at least two doses of when they are. During ISS, the supervisors observe if these sessions are being conducted in the ANC clinics. According to the results in the table above, 93 the hospitals and 91 the HC IVs found to be conducting health education sessions on malaria during ANC clinics. The results also show that none the HC IVs in Nakaseke District visited during this round of ISS conducting health education sessions on malaria during ANC clinics. The overall results for all the supervised reveal that 85 the conducting health education during the ANC clinics: Teso Region (85%), Hoima Region (83%) and Central Region (88%). The districts the lowest percentage of ANC clinics conducting health education Kaberamaido (69%), Kibaale (67%) and Hoima (70%). The SMP Communication and Community Mobilization Team will in the next quarter work the different DHTs in the poor performing districts to find solutions to the lack of health education sessions in the ANC clinics. 13 P age

2.2 Case Management 2.2.1 Referral of Emergency Cases HC IIIs and HC IIs are supposed to give pre- referral to patients diagnosed severe malaria before referring them to higher- level health. ISS results in the table above reveal that 81 the children under 5 referred to higher level pre- referral treatment. All children under 5 referred to higher level from HC IIIs and HC IIs for further management of severe malaria pre- referral treatment in Kaberamaido, Katakwi, Kiboga, Nakasongola, Rakai, and Bukomansimbi Districts. None of the children in Lwengo District treated. SMP, working the DHTs, will establish and address the reasons why some do not offer pre- referral treatment to patients diagnosed malaria before referring them for further management. District No. of HC IIs & HC IIIs Proportion of children under five referred for further management of malaria are first pre- referral treatment at HC II & III Central Region Bukomansimbi 12 100% Butambala 18 86% Kalungu 15 92% Lwengo 10 0% Masaka 23 95% Mpigi 23 94% Nakaseke 14 36% Nakasongola 30 100% Rakai 52 105% Wakiso 37 99% Central Region 234 81% Hoima Region Buliisa 9 91% Hoima 36 78% Kibaale 28 88% Kiboga 15 100% Kiryandongo 19 91% Kyankwazi 17 50% Masindi 31 78% Hoima Region 155 82% Teso Region Amuria 12 58% Bukedea 9 82% Kaberamaido 13 100% Katakwi 8 100% Kumi 12 23% Ngora 9 63% Serere 12 92% Soroti 8 31% 14 P age

No. of HC IIs & HC IIIs Proportion of children under five referred for further management of malaria are first pre- referral treatment at HC II & III Teso Region 83 69% SMP 472 81% 2.2.2 Status of Stock out Availability of s in all health is critical to the effective management of malaria. To ensure their continued availability in the SMP on a monthly basis tracks s in the and works in collaboration the SURE project to ensure that there are. From the collected during this round of ISS, 52 the hospitals and HC IVs reported no of s in the months of May, June and July 2011. All of the hospitals and HC IVs supervised in the districts of Amuria, Bukedea, Katwakwi, Serere, Soroti, and Kiboga experienced of s. The findings reveal that overall 53 all the visited did not experience in the month of May, June and July 2011; the Teso Region 44 no out is seen as the most likey region to face. The districts of Soroti (10%), Serere (26%), Bukedea (37%), and Kiboga (37%) had the lowest proportion of health no of s. As a matter of urgency SMP will encourage district health teams in the districts worst hit by the to arrange for redistribution of s from which supplies to those, as they await new supplies from the National Medical Stores. District HC IVs Hospitals District No. of HC IVs % of no No. of Hospitals % of no No. of HFs % of no Central Region Bukomansimbi 1 100% 0 1 100% Butambala 0 1 100% 1 100% Kalungu 1 100% 2 100% 3 100% Lwego 2 50% 0 2 50% Masaka 1 0% 1 100% 2 50% Mpigi 1 100% 1 0% 2 50% Nakaseke 3 67% 2 50% 5 58% Nakasongola 2 17% 1 0% 3 8% Rakai 1 67% 2 0% 3 33% Wakiso 7 71% 4 75% 11 73% Central Region 19 63% 14 53% 33 62% Hoima Region Buliisa 1 100% 0 1 100% Hoima 3 78% 1 0% 4 39% Kibaale 4 50% 1 33% 5 42% Kiboga 1 0% 1 0% 2 0% Kiryandongo 0 1 100% 1 100% Kyankwazi 1 100% 0 1 100% Masindi 0 1 100% 1 100% Hoima Region 10 66% 5 47% 15 69% Teso Region Amuria 2 0% 0 2 0% 15 P age

HC IVs Hospitals District No. of HC IVs % of no No. of Hospitals % of no No. of HFs % of no Bukedea 1 0% 0 1 0% Kaberamaido 1 100% 1 33% 2 67% Katakwi 1 0% 1 0% 2 0% Kumi 1 100% 2 50% 3 75% Ngora 1 0% 1 100% 2 50% Serere 1 0% 0 1 0% Soroti 2 0% 0 2 0% Teso Region 10 25% 5 46% 15 24% SMP 39 51% 24 49% 63 52% 2.3 Laboratory Diagnosis 2.3.1 Mainten Log According to the National Treatment Guidelines, diagnoses of malaria are supposed to be based on parasitological test either through microscopy tests or RDTs. Therefore, SMP continues to ensure that health microscopes keep an up- to- date laboratory equipment mainten log. The laboratory equipment mainten logs help the to ensure that the microscopes are serviced on schedule to avoid them giving incorrect test results due to defects. District HC IVs Hospitals District No. of No. of No. of HC IVs Health Facilities Hospitals Health Facilities HFs Health Facilities a laboratory mainten log a laboratory mainten log a laboratory mainten log Central Region Bukomansimbi 1 100% 0 1 100% Butambala 0 1 100% 1 100% Kalungu 1 50% 2 100% 3 75% Lwego 2 50% 0 2 50% Masaka 1 0% 1 100% 2 50% Mpigi 1 0% 1 100% 2 50% Nakaseke 3 100% 2 50% 5 75% Nakasongola 2 50% 1 100% 3 75% Rakai 1 100% 2 100% 3 100% Wakiso 7 14% 4 50% 11 32% Central Region 19 52% 14 88% 33 71% Hoima Region Buliisa 1 100% 0 1 100% Hoima 3 67% 1 0% 4 33% Kibaale 4 0% 1 100% 5 50% Kiboga 1 0% 1 100% 2 50% Kiryandongo 0 1 100% 1 100% Kyankwazi 1 100% 0 1 100% Masindi 0 1 100% 1 100% Hoima Region 10 53% 5 80% 15 76% Teso Region 16 P age

HC IVs Hospitals District No. of No. of No. of HC IVs Health Facilities Hospitals Health Facilities HFs Health Facilities a laboratory mainten log a laboratory mainten log a laboratory mainten log Amuria 2 100% 0 2 100% Bukedea 1 100% 0 1 100% Kaberamaido 1 100% 1 100% 2 100% Katakwi 1 0% 1 100% 2 50% Kumi 1 0% 2 100% 3 50% Ngora 1 100% 1 2 100% Serere 1 100% 0 1 100% Soroti 2 50% 0 2 50% Teso Region 10 69% 5 100% 15 81% SMP 39 58% 24 89% 63 76% The results in the table show that 89 the hospitals and 58 the HC IVs visited during this round of support supervision had up- to- date laboratory equipment mainten logs. The results also reveal that Teso Region had more hospitals (100%) and HC IVs (69%) up- to- date laboratory equipment mainten logs compared to the Hoima (hospitals 80%, HC IVs 53%), and the Central Region (hospitals 88%, HC IVs 52%). Overall 76 the hospitals and HC IVs had up- to- date laboratory equipment mainten logs. In the next round of ISS, SMP, working the district supervisors, will help no laboratory equipment mainten logs to develop them. 2.3.2 Availability of Laboratory Personnel 120% 100% 80% 60% 58% 82% 96% 51% 40% 20% 0% 22% HC II HC III HC IV Hospital Availability of laboratory personnel at all times in the functional laboratories is critical to ensure that all malaria diagnoses are based on parasitological tests. The results in the graph above reveal that 96 the hospitals, 82 HC IVs, 58 HC III and 22 HC IIs have their lab personnel available any time a malaria test is required. SMP has discussed this the facility incharge and district health teams to take action. 17 P age

2.3.3 Availability of Testing Protocols 120% 100% 92% 100% 80% 60% 68% 57% 40% 20% 0% 22% HC II HC III HC IV Hospital Testing protocols act a reference point for the laboratory personnel when they are carrying out malaria tests. The ISS findings show that all laboratories in the hospitals have testing protocols, compared to 92 HC IVs, 68 HC III and 22 HC IIs. SMP will work the district DHTs to ensure that all functional laboratories are supplied Testing Protocols. 2.4 Behaviour Change Communication and Community Mobilization SMP continued to support the community mobilization activities conducted by the health assistants in the selected districts and primary schools. The Stop Malaria in Your Community mass media campaign is also ongoing radio stations in the SMP supported districts. The information aired on radio is also reinforced by various billboards in selected districts as well as the community posters which have been supplied to all and are being hung in strategic points in the communities. 2.4.1 Health Facilities Displaying Malaria IEC Materials on Walls District HC IVs Hospitals District No. of HC IVs No. of Hospitals No. of HFs Central Region displaying IEC Materials for malaria wall displaying IEC Materials for malaria wall displaying IEC Materials for malaria wall Bukomansimbi 1 100% 0 1 100% Butambala 0 1 100% 1 100% Kalungu 1 50% 2 100% 3 75% Lwego 2 100% 0 2 100% Masaka 1 100% 1 100% 2 100% Mpigi 1 100% 1 100% 2 100% Nakaseke 3 50% 2 100% 5 75% Nakasongola 2 100% 1 100% 3 100% Rakai 1 0% 2 100% 3 50% Wakiso 7 71% 4 50% 11 61% Central Region 19 75% 14 94% 33 86% 18 P age

HC IVs Hospitals District No. of HC IVs No. of Hospitals No. of HFs displaying IEC Materials for malaria wall displaying IEC Materials for malaria wall displaying IEC Materials for malaria wall Hoima Region Buliisa 1 100% 0 1 100% Hoima 3 67% 1 100% 4 83% Kibaale 4 50% 1 0% 5 25% Kiboga 1 100% 1 100% 2 100% Kiryandongo 0 1 100% 1 100% Kyankwazi 1 100% 0 1 100% Masindi 0 1 100% 1 100% Hoima Region 10 83% 5 80% 15 87% Teso Region Amuria 2 100% 0 2 100% Bukedea 1 100% 0 1 100% Kaberamaido 1 100% 1 0% 2 50% Katakwi 1 100% 1 100% 2 100% Kumi 1 100% 2 100% 3 100% Ngora 1 100% 1 0% 2 50% Serere 1 100% 0 1 100% Soroti 2 100% 0 2 100% Teso Region 10 100% 5 50% 15 88% SMP 39 86% 24 75% 63 87% In order to enh the knowledge levels of the public about malaria, SMP continues to provide health, which are supposed to be of the health so that the patients and other visitors are able to read the information m. Therefore, during ISS, SMP continues to monitor health to ensure that they have the IEC for the patients and other members of the public to read. The ISS results in the table above show all HC IVs visited in Teso Region had malaria IEC. The hospitals visited that did not have IEC included; Ngora in Ngora District, Lwala in Kaberamaido District, Uganda Martyrs and Entebbe in Wakiso District, and Kagadi Hospital in Kibaale District. The HC IVs that did not have : Kyamulibwa in Kalungu District, Kaweweeta in Nakaseke District, Kakuuto in Rakai District, Gwatiro Nursing Home in Wakiso District, Kyagwali in Hoima District, and Kibaale HC IV in Kibaale District. 19 P age

2.4.2 Health Facilities BCC Materials 100% 80% 60% 61% 40% 38% 44% 43% 42% 20% 0% HC II HC III HC IV Hospital SMP SMP, through its communication support for the control and treatment of malaria, is mandated to produce and distribute BCC to all health it is supporting to be used as job aids. ISS is therefore used to monitor the availability and adequacy of these. The findings from this round of supervision reveal that only about 42 the health visited had BCC. 2.4.3 Health Facilities Health Assistants Attached 100% 80% 73% 60% 59% 61% 40% 20% 0% HC III HC IV Hospital All hospitals, HC IVs and HC IIIs are supposed to have a health assistant attached to them according to the MoH human resource guidelines. Among other duties, health assistants are supposed to conduct community sensitization and awareness activities about the key public health issues in the areas of the jurisdiction. The results from the supervised reveal that 61 hospitals, 73 HC IVs and 59 HC IIIs have a health assistant attached to them. 20 P age

2.5 Support Supervision 2.5.1 Support Supervision from Upper Levels 100% 90% 94% 90% 91% 92% 80% 60% 40% 20% 0% HC II HC III HC IV Hospital SMP According to the MoH support supervision guidelines, health are supposed to be supervised by those which are at a higher level: for example, HC IIs should be supervised by HC IIIs and hospitals should be supervised by the districts or MoH. According to the graph above, nearly all health (92%) reported to have been supervised by higher level or authorities. 2.6 Health Management Information System (HMIS) During the quarter, SMP provided support to DHTs to orient health workers revised HMIS tools through on job training; this opportunity also used by the districts to conduct quality assessments in the. 2.6.1 Health Facilities Analyzing and Utilizing Data for Decision Making Part of the SMP support towards districts and health is geared towards improving HMIS collection, and use. Up- to- date graphs for the key health sector indicators is therefore used as a measure for and use at the health facility. From the results in the table above, none of the hospitals and HC IVs in Bukomansimbi, Butambala, Nakaseke, Nakasongola, Rakai, Kyankwazi, and Masindi Districts had evidence of and use; while all of those in Buliisa, Kiryandongo, Bukedea, Serere, Soroti Districts had evidence of and use of. The Teso Region (66%) had the highest percentage of hospitals and HC IVs evidence of and use. It is also interesting to note that HC IVs (55%) had more evidence of use and compared to hospitals (32%). Overall, only 47 the hospitals and HC IVs visited had evidence of and use. Overall only 32% (Appendix: Table 1) of the health visited had evidence of and use. The districts of Bokomansimbi (15%), Kiboga (12%), Nakaseke (5%) and Lwengo (17%) had the lowest percentage of health evidence of and use. To address this gap SMP is currently working MoH Resource Centre to develop a training plan and manuals, which will be used to train different health workers in the on and use. 21 P age

Appendix Table 1: Criteria for Ranking in SMP Supported Districts District 1 2 Quarter 4 no Central Region Bukomansimbi Butenga HC HC IV 78% 52% No Yes Yes Yes No 100% 57% 5 Bukomansimbi Bigasa HC III 88% 43% No No No No Yes 0% 25% 10 Bukomansimbi Kitaasa HC HC III 97% 39% No Yes No No Yes 0% 38% 8 Bukomansimbi Kawoko HC III HC III 0% 0% No Yes Yes No Yes 100% 50% 6 Bukomansimbi Luyitayita HC III 51% 31% No Yes Yes No No 100% 43% 7 Bukomansimbi Kabigi HC HC III 103% 87% No Yes Yes No Yes 100% 75% 1 Bukomansimbi St.Mary's HC III 55% 24% Yes No Yes No Yes 100% 50% 6 Nursing Home Bukomansimbi Makukulu HC HC III 102% 55% No Yes Yes No Yes 100% 63% 4 Bukomansimbi Buyoga HC III 68% 6% Yes Yes Yes No Yes 0% 50% 6 Bukomansimbi Mirambi HC HC III 83% 44% Yes Yes Yes No No 100% 71% 2 Bukomansimbi Kijanda HC III 77% 34% No Yes Yes No Yes 100% 50% 6 Bukomansimbi Kisojo HC HC II NO ANC NO ANC NO ANC NO ANC No Yes No 100% 67% 3 Bukomansimbi Kigangazi HC II 90% 33% No No No No No 100% 29% 9 Bukomansimbi 74% 37% 25% 75% 69% 15% Yes 77% 52% 8 Butambala Gombe Hospital Hospital 53% 13% Yes Yes Yes Yes Yes 100% 75% 2 Butambala Kyabadaaza HC III 54% 42% Yes Yes Yes No Yes 100% 63% 5 25 P age

1 2 Quarter 4 no Butambala Kibibi Nursing HC III 87% 49% No Yes Yes Yes No 0% 57% 6 Home Butambala Kitimba HC III 86% 37% Yes Yes Yes No No 0% 57% 6 Butambala Our Lady of HC III 42% 8% Yes Yes Yes Yes Yes 0% 63% 5 Assumpta Butambala Bulo HC HC III 84% 56% Yes Yes Yes No No 0% 57% 6 Butambala Ngando HC III 80% 54% Yes Yes Yes Yes Yes 33% 79% 1 Butambala Epi Centre HC III 85% 20% Yes Yes Yes No No Butambala Kawonawo Domiciliary Home HC II 95% 43% Yes Yes Yes No No 100% 71% 3 100% 71% 3 Butambala Kalamba HC II 67% 27% Yes Yes Yes No Yes 33% 54% 7 Butambala Kabasanda HC II NO ANC NO ANC NO ANC NO ANC No No No 0% 0% 10 Butambala Sanyu HC II 58% 51% Yes Yes Yes Yes No 0% 57% 6 Domiciliary Butambala Kiddawalime HC II 72% 62% Yes Yes Yes No No 0% 71% 3 Nursing Home Butambala Butaaka HC II NO ANC NO ANC NO ANC NO ANC No Yes Yes 100% 75% 2 Butambala Bulo Clinic HC II NO ANC NO ANC NO ANC NO ANC No No Yes 100% 50% 8 Butambala Butende HC HC II NO ANC NO ANC NO ANC NO ANC No No Yes 100% 50% 8 Butambala Bugobango HC II NO ANC NO ANC NO ANC NO ANC No Yes No 100% 67% 4 Butambala Nsozibirye HC II NO ANC NO ANC NO ANC NO ANC No No Yes 100% 50% 8 Butambala Kirokora HC II NO ANC NO ANC NO ANC NO ANC No Yes No 0% 33% 9 Butambala 72% 39% 92% Yes 63% 42% Yes 51% 64% 2 26 P age

1 2 Quarter 4 no Kalungu Villa Maria Hospital 42% 21% No Yes Yes Yes Yes 100% 63% 4 Kalungu Bukulu HC HC IV 73% 49% Yes Yes Yes Yes No 0% 57% 5 Kalungu Kyamulimbwa HC IV 106% 87% No Yes No No No 67% 52% 6 Kalungu Lukaya HC III 53% 47% Yes Yes Yes No No 100% 57% 5 Kalungu Kabungo HC III 106% 63% Yes Yes No No No 0% 57% 5 Kalungu Kyamulimbwa HC III 106% 79% No No Yes No No 100% 57% 5 Kalungu kabale HC III 61% 58% No Yes Yes No Yes 33% 42% 9 Kalungu Kiraga HC III 89% 65% No Yes Yes No Yes 33% 67% 3 Kalungu kasambya HC III 100% 51% No Yes Yes No No 0% 43% 8 Kalungu Kiti HC III 93% 54% No Yes Yes No No 0% 43% 8 Kalungu Kalungi HC III 108% 77% No Yes Yes No Yes 100% 75% 1 Kalungu Kalungu HC III 102% 58% No Yes Yes Yes No 100% 71% 2 Kalungu St. Monica HC II 120% Data not No No Yes No No 100% 50% 7 Birongo considered Kalungu Kigasa HC II 87% 27% No No Yes No Yes 100% 50% 7 Kalungu Bwanda HC II NO ANC NO ANC NO ANC NO ANC No No Yes 33% 33% 9 Kalungu Lusanga BL HC II 71% 86% No Yes Yes Yes Yes 100% 75% 1 Kalungu Kigaju HC HC II 44% 24% No Yes Yes Yes No 67% 52% 6 Kalungu Nabutongwa HC II 31% 31% No Yes No No No 100% 29% 10 Kalungu 82% 55% 18% 82% 78% 28% Yes 63% 58% 6 27 P age

1 2 Quarter 4 no Lwengo Kiwangala HC IV 0% 0% No No Yes Yes No 67% 38% 6 Lwengo Lwengo HC IV 88% 52% Yes Yes Yes No No 100% 71% 2 Lwengo Kinoni HC III 72% 47% Yes Yes Yes No No 100% 57% 3 Lwengo Kitoro Luyembe HC III 97% 44% Yes Yes Yes No No 0% 57% 3 Lwengo Nanywa HC III 26% 2% Yes Yes No No No 33% 33% 7 Lwengo katovu HC III 94% 53% No No Yes No Yes 0% 38% 6 Lwengo Kyetume HC III 90% 49% Yes Yes Yes No No 100% 71% 2 Lwengo Kyamaganda HC III 100% 89% Yes Yes Yes No No 100% 86% 1 Lwengo Makondo HC II 0% 0% Yes Yes Yes No Yes 0% 50% 4 Lwengo Kisansala HC II 0% 0% Yes Yes Yes No No 0% 43% 5 Lwengo Kinenewe HC II 0% 0% Yes Yes Yes Yes No 100% 71% 2 Lwengo Kakooma HC II 44% 15% No Yes No No No 0% 14% 8 Lwengo 51% 29% 75% 83% 83% 17% Yes 50% 57% 7 Masaka Kitovu Hospital Hospital 101% 95% Yes Yes Yes No No 100% 86% 3 Masaka Kiyumba HC HC IV 67% 42% No Yes Yes No No 0% 29% 14 Masaka Bukeeri HC III 93% 57% No Yes Yes No No 0% 43% 12 Masaka Buwunga HC III 100% 42% No Yes Yes No No 0% 43% 12 Masaka Butende HC III 90% 37% Yes Yes Yes No Yes 0% 63% 7 Masaka Kasijjagirwa HC III 0% 0% Yes Yes Yes No No 100% 57% 8 28 P age

1 2 Quarter 4 no Masaka Bukoto HC III 89% 65% No Yes Yes No No 0% 57% 8 Masaka Ssunga HC HC III 69% 35% No Yes Yes Yes Yes 100% 63% 7 Masaka Mpugwe HC III 86% 44% No No Yes Yes No 0% 57% 8 Masaka Bukakata HC III 78% 38% No Yes Yes Yes Yes 0% 50% 10 Masaka Mazinga HC II 143% 83% No Yes Yes No Yes 67% 71% 6 Masaka Lambu HC II 90% 15% Yes Yes Yes Yes Yes 100% 88% 2 Masaka MM Clinic HC II 0% 0% No Yes Yes No No 0% 29% 14 Masaka Makonzi HC II 67% 24% No No Yes No Yes 100% 38% 13 Masaka Kamulegu HC II 107% 40% No Yes Yes No No 33% 48% 11 Masaka Bugabira HC II 126% 46% No Yes Yes Yes Yes 100% 75% 5 Masaka Kirumba HC II 69% 43% No Yes Yes Yes No 67% 52% 9 Masaka Kamwoozi HC II 65% 60% Yes Yes Yes Yes No 33% 76% 4 Masaka Nakasojjo HC II 77% 36% No Yes Yes Yes Yes 0% 50% 9 Masaka Buyaga HC II 102% 80% Yes Yes Yes Yes Yes 100% 100% 1 Masaka Kitabaazi HC II 95% 66% Yes Yes Yes No Yes 100% 88% 2 Masaka Kyabakuza HC HC II 24% 6% No No Yes No No 0% 14% 15 Masaka Kako HC II 100% 40% No Yes Yes No Yes 0% 50% 10 Masaka Kitunga HC II 62% 34% Yes Yes Yes No No 0% 43% 12 Masaka Zzimwe HC HC II 0% 0% No Yes Yes No No 0% 29% 14 Masaka 76% 41% 32% 88% Yes 36% Yes 40% 60% 4 29 P age

1 2 Quarter 4 no Mpigi Nkoli Hospital. Hospital 77% 69% No Yes Yes Yes Yes 0% 50% 8 Mpigi Mpigi Health HC IV 81% 47% Yes Yes Yes No Yes 100% 75% 2 Centre Mpigi Golli HC III 55% 36% Yes No Yes Yes No 100% 57% 5 Mpigi Ssekiwunga HC III 42% 23% Yes Yes Yes No Yes 33% 54% 6 Mpigi Kibanga HC HC III 83% 0% Yes No Yes No Yes 100% 63% 4 Mpigi Buwama HC HC III 93% 61% No No Yes No No 100% 57% 5 Mpigi Muduuma HC III 55% 87% No Yes Yes Yes Yes 100% 75% 2 Mpigi Mitala Maria HC III 34% 20% Yes Yes Yes Yes No 100% 71% 3 Mpigi St.Monica HC III 59% 72% Yes Yes Yes Yes Yes 100% 88% 1 Katende Mpigi Nindye HC HC III 61% 33% Yes Yes Yes Yes No 100% 71% 3 Mpigi Bunjako HC HC III 55% 31% No Yes Yes Yes No 100% 57% 5 Mpigi Kampiringisa HC III 82% 14% Yes Yes Yes Yes Yes 0% 88% 1 Mpigi Butooro HC HC III 54% 45% Yes Yes Yes No No 67% 52% 7 Mpigi Double Cure HC III 67% 40% No Yes Yes No Yes 100% 50% 8 Mpigi Kituntu HC HC III 66% 33% No Yes Yes No Yes 0% 38% 10 Mpigi Nswanjere HC III 60% 40% Yes Yes Yes No No 100% 57% 5 Mpigi Bujuuko HC HC III 85% 56% Yes No Yes No No 0% 43% 9 Mpigi Kyali HC III 94% 57% Yes Yes Yes Yes No 0% 71% 3 Mpigi Golo HC HC III 84% 55% Yes Yes Yes No Yes 100% 75% 2 Mpigi Bukasa HC III 0% 0% Yes Yes Yes No Yes 33% 54% 6 30 P age

1 2 Quarter 4 no Mpigi Kkonge HC HC II 13% 6% Yes Yes Yes Yes No 100% 71% 3 Mpigi Kibumbiro HC HC II NO ANC NO ANC NO ANC NO ANC No No No 33% 11% 12 Mpigi Epi Centre HC II 54% 31% Yes Yes Yes Yes No 0% 57% 5 Kiklingente Mpigi Kafumu HC HC II NO ANC NO ANC NO ANC NO ANC No Yes No 100% 67% 4 Mpigi Nabyewanga HC HC II 50% 27% No Yes Yes No No 33% 33% 11 Mpigi 61% 38% 7No 83% 92% 48% Yes 64% 63% 3 Nakaseke Nakaseke Hospital 91% 68% No Yes Yes No No 0% 57% 6 Hospital Nakaseke Kiwoko Hospital Hospital 73% 42% Yes Yes Yes No No 100% 57% 6 Nakaseke Semuto HC IV 100% 88% Yes Yes Yes No No 0% 71% 4 Nakaseke Ngoma HC HC IV 93% 34% Yes No Yes No No 100% 57% 6 Nakaseke Kaweweeta HC IV NO ANC NO ANC NO ANC NO ANC No No Yes 67% 42% 9 Nakaseke Kirema HC HC III 123% 105% Yes Yes Yes No Yes 100% 88% 1 Nakaseke Bidabugya HC HC III 71% 50% Yes Yes Yes No No 100% 57% 6 Nakaseke Kikamulo HC III 94% 36% Yes Yes Yes No Yes 0% 63% 5 Nakaseke Kapeeka HC III 88% 58% Yes Yes Yes No No 100% 71% 4 Nakaseke Wakyato HC HC III 82% 67% Yes No Yes No Yes 100% 75% 3 Nakaseke Namusale HC II 98% 90% Yes Yes Yes No Yes 67% 83% 2 Nakaseke Kabogye HC II 99% 121% No Yes Yes No No Nakaseke Lusanjja HC II 98% 53% Yes Yes Yes No No 0% 57% 6 100% 71% 4 31 P age

1 2 Quarter 4 no Nakaseke Ngoma HC II 102% 40% Yes Yes Yes Yes Yes 100% 88% 1 Nakaseke Kalege HC II 78% 23% No Yes Yes No No 0% 29% 10 Nakaseke Kalagala HC HC II 83% 50% No Yes Yes No Yes 100% 63% 5 Nakaseke Bulyake HC HC II 92% 44% Yes Yes Yes No No 0% 57% 6 Nakaseke Nakaseeta HC II 83% 37% Yes Yes No No 0% 50% 7 Nakaseke Kigege HC HC II 73% 45% No Yes Yes No No 0% 43% 8 Nakaseke 90% 58% 71% 89% 95% 5% Yes 54% 66% 1 Nakasongola Nakasongola Hospital 47% 33% No Yes Yes Yes Yes 67% 58% 9 Nakasongola Franciscan HC IV 74% 38% Yes Yes No No 100% 50% 11 Nakasongola Nakasongola HC IV HC IV 77% 60% No Yes Yes No Yes 0% 38% 14 Nakasongola Nabiswera HC III 68% 40% No Yes Yes No No 0% 29% 15 Nakasongola Nakayonza HC III 71% 81% No Yes No No No 0% 29% 15 Nakasongola Kalungi HC HC III 101% 66% Yes Yes No No Yes 100% 75% 4 Nakasongola Kakooge HC HC III 91% 48% No Yes Yes No No 100% 57% 10 Nakasongola Nakasongola HC III 0% 0% Yes Yes Yes No No 100% 57% Prison 10 Nakasongola Lwampanga HC HC III 68% 54% No Yes No No No 0% 14% 16 Nakasongola Our Lady HC III 82% 33% No Yes Yes No No 33% 48% 12 Nakasongola Wabigalo HC III 89% 64% Yes No Yes No Yes 0% 63% 7 Nakasongola Nakitoma HC III 71% 46% No Yes Yes No No 0% 29% 15 32 P age

1 2 Quarter 4 no Nakasongola Bamugolodde HC III 88% 57% No Yes Yes Yes No 67% 67% 6 HC Nakasongola Lwabiyata HC II 73% 21% No Yes Yes No Yes 100% 50% 11 Nakasongola Wampiti HC II 77% 89% No Yes Yes No Yes 100% 63% 7 Nakasongola Kamunina HC HC II 67% 22% No Yes Yes No No 100% 43% 13 Nakasongola Walukunye HC HC II 88% 46% Yes Yes Yes Yes Yes 100% 88% 2 Nakasongola Kakoola HC II 92% Data not considered Yes Yes Yes Yes No 67% 95% 1 Nakasongola Kiwambya HC II 41% 54% Yes Yes Yes Yes No 100% 71% 5 Nakasongola Jeru HC II 105% 51% No Yes Yes No No 0% 43% 13 Nakasongola Buyamba HC II 86% 49% Yes Yes Yes No No 0% 57% 10 Nakasongola Mayirikiti HC II 99% 36% No Yes Yes No No 0% 43% 13 Nakasongola Kyeyindula HC HC II 141% 47% No Yes No No Yes 0% 38% 14 Nakasongola Mulonzi HC HC II 78% 67% Yes Yes Yes Yes No 100% 86% 3 Nakasongola Kisalizi HC HC II 99% 47% Yes Yes Yes No Yes 0% 63% 7 Nakasongola Kikooge HC II 82% 80% No Yes Yes No No 0% 57% 10 Nakasongola Kilaramba HC HC II 86% 38% Yes Yes Yes No Yes 0% 63% 7 Nakasongola Kazwama HC HC II 87% 94% No Yes Yes No No Nakasongola Batuusa HC HC II 85% 43% No Yes Yes Yes No Nakasongola Kasozi HC II 79% 47% Yes Yes No Yes No Nakasongola Muwunami HC HC II 78% 42% No No No No No 0% 57% 10 33% 62% 8 100% 57% 10 100% 14% 16 33 P age

1 2 Quarter 4 no Nakasongola Kikoiro HC II 90% 23% No Yes No No No 0% 29% 15 Nakasongola Sikye HC II 122% 128% Yes No No No No 100% 57% 10 Nakasongola 81% 51% 38% 91% 76% 24% Yes 47% 57% 7 Rakai Rakai Hospital Hospital 47% 27% Yes Yes Yes Yes No 100% 71% 4 Rakai Kalisizo Hospital Hospital 72% 46% Yes Yes Yes No Yes 0% 50% 10 Rakai Kakuuto HC IV 32% 13% No Yes No Yes Yes 100% 50% 10 Rakai Kimuli HC HC III 81% 47% No Yes Yes No No 100% 71% 4 Rakai Mitukula HC III 72% 23% No Yes Yes No No 100% 43% 12 Rakai Kirumba HC III 104% 77% No Yes No No Yes 100% 63% 6 Rakai Kibanda HC III 55% Data not considered No Yes Yes No No 100% 50% 10 Rakai Lwamagwa HC HC III 118% 77% Yes Yes Yes Yes No 100% 100% 1 Rakai Kacheera HC III 95% 51% No Yes Yes No Yes 100% 63% 6 Rakai Kifamba HC III 89% 53% No Yes Yes No No 0% 43% 12 Rakai Bethlem HC III 71% 16% No Yes No No No 100% 29% 14 Rakai Buyamba HC HC III 91% 49% No Yes Yes No Yes 67% 58% 7 Rakai Mitukula HC III 72% 18% No Yes Yes No No 100% 43% 12 Rakai Lwankoni HC III 57% 65% No Yes Yes No No 0% 43% 12 Rakai Bikira HC HC III 72% 43% Yes Yes No No Yes 67% 46% 11 Rakai Kabuwoko HC HC III 96% 82% Yes No Yes Yes Yes 0% 63% 6 Rakai Kasaali HC III 69% 23% Yes Yes Yes Yes No 0% 57% 8 34 P age

1 2 Quarter 4 no Rakai Byakabanda HC III 58% 43% Yes Yes Yes No No 0% 43% 12 Rakai Lwanda HC III 112% 117% No Yes Yes No Yes 0% 63% 6 Rakai Kasasa HC III 83% 75% No Yes No No Yes 0% 50% 10 Rakai Kyebe HC III 76% 52% No Yes No Yes Yes 0% 38% 13 Rakai Mutukula HC III 100% 50% No Yes Yes Yes No 100% 86% 2 Rakai Ndolo HC II 74% 35% No Yes Yes No No 0% 29% 14 Rakai Kayanja HC II 75% 49% No Yes Yes Yes Yes 67% 58% 7 Rakai Nabyajwe HC II 0% 0% No Yes Yes No No 0% 29% 14 Rakai St.Martin HC II 125% 101% Yes Yes Yes Yes No 0% 86% 2 Rakai Buyisa HC HC II 109% 54% No Yes No Yes 0% 43% 12 Rakai Lwamagwa NGO HC II 59% 57% Yes Yes Yes No No Rakai Kyabigonda HC II 111% 52% No Yes Yes No No Rakai Buyamba HC II 98% 39% Yes Yes No No No dispensary Rakai Kakundi HC HC II 93% 46% Yes Yes Yes No No Rakai Kibuuka HC HC II 102% 28% No Yes Yes No No Rakai Kijeja HC II 62% 32% No Yes Yes Yes No Rakai Buziranduru HC II 72% 30% No Yes Yes No No Rakai Nkenge HC HC II 83% 54% Yes Yes Yes No No 0% 43% 12 0% 43% 12 100% 57% 8 0% 57% 8 100% 57% 8 0% 43% 12 0% 29% 14 67% 67% 5 35 P age

1 2 Quarter 4 no Rakai Gayaza HC II 62% 70% No Yes Yes No Yes 100% 63% 6 Rakai Kyakanda HC II 142% 120% No Yes Yes No No 0% 57% 8 Rakai Butembe HC HC II 78% 34% No Yes Yes No Yes 100% 50% 10 Rakai Bbaka HC II 111% 104% Yes Yes No Yes No 0% 71% 4 Rakai Kabuwoko HC II 79% 121% Yes Yes No No Yes 100% 63% 6 Rakai Byerima HC II 81% 53% No Yes No No Yes 67% 46% 11 Rakai Kyakanyomozi HC II 84% 45% No Yes Yes No Yes 33% 54% 9 Rakai Miculugiro HC HC II 18% 12% No Yes Yes Yes No 100% 57% 8 Rakai Kabusota HC HC II 60% 30% No Yes Yes No No 0% 29% 14 Rakai Mbuye HC II 70% 33% No Yes No No No 100% 29% 14 Rakai Kagamba HC HC II 88% 86% No Yes Yes No Yes 100% 75% 3 Rakai Lwabakooba HC HC II 76% 73% No Yes No No No 100% 43% 12 Rakai Bugona HC II 61% 52% No Yes Yes No No 100% 43% 12 Rakai Mayanja HC II 79% 47% No No Yes No Yes 100% 38% 13 Rakai St Jude Sanje HC II 44% 24% No Yes Yes No Yes 100% 50% 10 Rakai Sanje HC II 97% 60% No Yes No No No 100% 57% 8 Domicilliary Rakai Kijonjo HC II 59% 20% Yes Yes Yes No No 100% 57% 8 Rakai Gwanda HC II 95% 42% No Yes Yes No Yes 100% 63% 6 Rakai Kasensero HC II 103% 49% No Yes Yes Yes Yes 0% 63% 6 Rakai Minziiro HC II 83% 47% No Yes Yes No Yes 100% 63% 6 36 P age

1 2 Quarter 4 no Rakai 79% 51% 27% 96% 75% 24% Yes 56% 57% 7 Wakiso Entebbe Hospital 82% 56% No Yes No No No 100% 57% 7 Hospital Wakiso Namugongo Hospital 58% 62% Yes Yes No No Yes 67% 58% 6 Hospital Wakiso Saldina Hospital 45% 37% No Yes Yes Yes No 0% 43% 9 Abubakar Wakiso Kisubi Hospital 62% 39% Yes Yes Yes Yes Yes 0% 63% 5 Wakiso Ndejje HC IV 43% 30% No Yes Yes No Yes 0% 38% 12 Wakiso Wakiso HC HC IV 68% 49% No Yes Yes No No 0% 29% 13 Wakiso Gwatiro Nursing HC IV 0% 0% No Yes No No No 0% 14% 14 Home Wakiso Wagagai HC IV 67% 55% Yes Yes No No No 67% 38% 11 Wakiso Kasangati HC HC IV 59% 40% No Yes Yes No No 100% 43% 9 Wakiso Buwambo HC HC IV 79% 59% Yes Yes Yes Yes Yes 0% 63% 5 Wakiso Namayumba HC IV 82% 20% Yes Yes Yes Yes No 100% 86% 2 Wakiso Nampunge HC III 48% 8% No Yes No No No 100% 29% 13 Wakiso Wattuba HC III 121% 87% No Yes Yes Yes No 100% 86% 2 Wakiso Epi Centre HC III 80% 36% No Yes Yes Yes Yes 100% 75% 3 Wakiso Kasanje HC III 88% 58% Yes No Yes No No 100% 57% 7 Wakiso Luwunga HC III 56% 18% No Yes Yes Yes Yes 67% 58% 6 Barracks Wakiso Kakiri HC HC III 100% 88% Yes Yes Yes Yes No 0% 86% 2 Wakiso Zia Angellina HC III 97% 86% Yes Yes Yes No Yes 100% 88% 1 37 P age

1 2 Quarter 4 no Wakiso Kasozi HC HC III 76% 54% Yes Yes Yes No Yes 100% 63% 5 Wakiso Kiziba St. Ulrica HC III 90% 49% No No Yes No Yes 100% 50% 8 Wakiso Kiziba HC III 79% 72% Yes Yes Yes No No 100% 71% 4 Wakiso Kajjansi HC III 72% 41% No Yes No Yes Yes 33% 42% 10 Wakiso Nende HC III 85% 49% No No Yes Yes Yes 0% 50% 8 Wakiso Kigungu HC III 65% 21% Yes Yes No No Yes 100% 50% 8 Wakiso Hassan Turabi HC III 82% 9% Yes Yes Yes No No 100% 71% 4 Wakiso Mirembe HC HC III 54% 32% Yes Yes No Yes Yes 100% 63% 5 Wakiso Foyer HC HC III 0% 0% No Yes Yes Yes Yes 100% 63% 5 Wakiso Nabutiti HC HC III 82% 26% Yes Yes Yes No Yes 100% 75% 3 Wakiso Nabweru HC HC III 80% 54% Yes Yes Yes No No 100% 71% 4 Wakiso Kira HC HC III 62% 68% No Yes Yes No No 100% 57% 7 Wakiso Nsangi HC HC III 74% 33% No Yes Yes No Yes 100% 50% 8 Wakiso Buyege HC III 69% 21% Yes Yes Yes Yes Yes 0% 63% 5 Wakiso Kawanda HC HC III 72% 53% No Yes Yes No Yes 0% 38% 11 Wakiso Kireka SDA HC III 76% 38% Yes Yes No Yes Yes 0% 50% 8 Wakiso Bussi HC III 64% 51% No Yes Yes Yes No 0% 43% 9 Wakiso Jjanda HC III 82% 60% Yes Yes No Yes No 100% 86% 2 Wakiso Taqwa HC III 100% 83% No Yes Yes No No 100% 71% 4 Wakiso Bulondo HC III 68% 68% No Yes Yes No Yes 100% 63% 5 Wakiso Lufuka Valley HC III 39% 4% No Yes Yes No No 100% 43% 9 38 P age

1 2 Quarter 4 no Wakiso St.Appollo HC III 102% 0% No Yes Yes No Yes 100% 63% 5 Wakiso Ttikalu HC III 68% 19% No Yes Yes No Yes 100% 50% 8 Wakiso Namulonge HC HC III 78% 43% No Yes No No Yes 100% 38% 11 Wakiso Katabi Military HC III 41% 7% No Yes Yes No Yes 33% 42% 10 Hospital Wakiso Bweyogerere HC HC III 60% 13% No Yes Yes No Yes 0% 38% 11 Wakiso Nakawuka HC III 66% 39% Yes Yes Yes Yes No 100% 71% 4 Wakiso Kabubbu HC HC III 76% 40% No Yes Yes No No 0% 29% 13 Wakiso Busawamanze HC III 102% 63% No Yes Yes No Yes 100% 75% 1 Wakiso Brother Amans HC II 17% 74% No Yes No No No 100% 43% 9 Wakiso 69% 42% 4No 94% 75% 35% Yes 66% 59% 5 Central Region 74% 44% 49% 88% 81% 27% Yes 57% 59% 3 Hoima Region Buliisa Buliisa HC HC IV 97% 77% Yes Yes Yes No Yes 100% 88% 2 Buliisa Biiso HC III 85% 64% Yes Yes Yes Yes Yes 100% 100% 1 Buliisa Paara HC II 96% 75% Yes Yes Yes Yes No 100% 100% 1 Buliisa Kigwera HC HC II 147% 79% Yes Yes Yes No Yes 33% 79% 4 Buliisa Bugoigo HC HC II 83% 50% Yes Yes Yes Yes No 100% 86% 3 Buliisa Avogera HC HC II 102% 64% Yes Yes Yes No Yes 100% 88% 2 Buliisa Butiaba HC II 90% 44% Yes Yes Yes No Yes 33% 67% 6 Buliisa Sofrad HC HC II 0% 0% Yes Yes Yes No No 0% 43% 7 39 P age

1 2 Quarter 4 no Buliisa Kihungya HC II 84% 53% Yes Yes Yes Yes No 100% 86% 3 Buliisa Uganda Martyrs HC II NO ANC NO ANC NO ANC NO ANC No Yes Yes 100% 75% 5 HC Buliisa 87% 56% Yes Yes 9No 5No Yes 77% 83% 1 Hoima Hoima RRH Hospital 78% 28% No Yes Yes No Yes 0% 38% 10 Hoima Kyangwali HC IV 95% 58% No No No Yes No 100% 57% 7 Hoima Kugolobya H/C HC IV 58% 39% No Yes Yes Yes Yes 100% 63% 6 Hoima Kikuube HC IV 48% 28% Yes Yes Yes No No 0% 43% 9 Hoima Bujumbura HC III 45% 46% Yes Yes No No Yes 0% 38% 10 Hoima Azur Clinic HC III 83% 52% No Yes Yes No Yes 100% 63% 6 Hoima Kabwooya HC III 105% 53% No Yes Yes No No 100% 57% 7 Hoima Munteme HC III 97% 135% Yes Yes Yes Yes Yes 100% 100% 1 Hoima Bugambe HC HC III 92% 45% Yes Yes Yes No Yes 100% 75% 4 Hoima Kseeta HC III 112% 67% Yes Yes Yes Yes Yes 0% 88% 2 Hoima Karongo HC III 106% 56% Yes Yes No No No 0% 43% 9 Hoima Dwooli HC III 100% 82% Yes Yes No No Yes 0% 63% 6 Hoima Bujalya HC III 82% 94% Yes No Yes No No Hoima Buhimba HC III 108% 46% No No Yes Yes No Hoima Rwenyawawa HC III 79% 38% No Yes Yes No No Hoima Buseruka HC III 85% 44% No Yes Yes No No Hoima Mukabara HC III 107% 80% Yes Yes Yes No No 0% 57% 7 0% 43% 9 0% 29% 12 100% 57% 7 0% 71% 5 40 P age