Education and Health Services in

UGANDA
Data for Results and Accountability
NOVEMBER 2013

SDI: An Africa-wide initiative

SOUTH AFRICA

Acknowledgements

Government of Uganda EPRC

SDI Partnership: World Bank, AERC, AfDB

Process: Consultation, design and adaptation of survey materials

Instrument design:
Methodology underpinned by state-of-the-art research Methodology piloted in Tanzania and Senegal

Adaptation of survey instruments to Uganda context through technical consultations

Consultations held prior to survey in Kampala with GoU, non-government stakeholders, and sector experts Survey coverage: representative of health facilities and schools across the country and for each region SDI did not include higher level health facilities such as HC4s and hospitals

SDI aims to shed light on behavior at service delivery units

Maternal mortality ratio 438/100,000 (UDHS 2011)

Inputs

Health: UGX 850 Bil (2011-12, 8% of budget)

Behavior
Education: UGX 1.6 Tr. (2011-12, 15% of budget) Expenditure Value for Money, Quality, and Equity
5

6/10 P4 pupils cannot read sentence at P2 level (Uwezo 2011)

Outcomes

What does SDI measure?

Education Findings

Input availability
Schools do well on infrastructure and equipment

except for textbooks

Uganda Public Teaching equipment School infrastructure Pupil-teacher ratio 94% 55% 39 94% 60% 46 Private 95% 40% 19
Private 3% Uganda 11%

Public

14%

What teachers do
Teachers Effort
Uganda Public Private
School absence rate Classroom absence rate 24% 53% 27% 57% 14% 40%
Out of 100 Ugandan primary
teachers
Uganda 39 52 28 1 50 29 9 35 12 34 7 2 29 24 1 27 2 2 4 35 0 11 26 24 18

Western
Northern Kampala

Classroom teaching time

Eastern

3h19m

2h58m

4h18m
Central

42

11

25

22

In classroom teaching

In classroom not teaching

Private school: 50% more instruction

9

In school not teaching

Absent from school

Teaching outdoors

What teachers know

Teachers test scores
65% 58%

Minimum Knowledge
23% 20% 18%

Teachers score much lower on teaching skills assessment

26%

Maths score

English score

Pedagogy score

Uganda

Rural

Urban

. according to the Uganda SDI data, students performance is strongly enhanced by teachers knowledge

Regional disparities
Students per class
Northern classes 3 times larger than Kampalas
39 29 20 32 58 51

Time spent teaching per day (minutes) Northern students receive 2.5 times less teaching time
223

283 237

197
164

112

Kampala Central Western Uganda Eastern Northern

Kampala

Western

Central

Uganda

Eastern

Northern

SDI: Uganda vs Kenya

What teachers do: absenteeism
Uganda Kenya Uganda
53% 42%

What teachers know: minimum knowledge

Kenya
75%

24% 16% 10% 4% Absence from School Absence from Classroom

36%

English

Mathematics

Education summary
Ugandan primary schools do well in terms of infrastructure and equipment but textbook use is a challenge Teachers absenteeism both from school and classroom is a concern and is more serious in public schools and rural areas Only a small share of teachers in public and private schools alike master the curriculum they are supposed to teach There are large regional disparities

13

Health Findings

Infrastructure Availability
Electricity Uganda 73% Clean water 93%
Public
97% 89% 88% 91% 90% 79%

Improved toilet 89%

Private

Minimum infrastructure 64%

57% 47%

Clean water

Sanitation

Electricity

Minimum Infrastructure (all three)

Drugs and equipment availability

Uganda Tracer drugs 79% Mothers drugs 35% Children drugs 49%
Rural
81% 74% 60%

HC2 drugs 58%

Equipment 83%

Urban
81% 85%

58% 44% 43%

57%

29%

Tracer drugs

Mothers drugs

Children drugs

HC2 drugs

Equipment

What health providers do

Absence from facility Uganda 46% Private 39% Public 52%

Absence by location and facility type

Rural Urban
53%

Reason for absence

Other 19%

44%

46% 39%

Not approved Absence

22%

Approved absence

26%

Official mission

11%

In training/seminar

15%

Sick/maternity

8%

HC 2

HC 3

What health providers know

A large gap between diagnostic and treatment
Full Treatment
Management of maternal /neonatal complications

Correct Diagnosis
36%
58%

19%

All

Adherence to clinical Guidelines

Malaria with Anemia 50% Pulmonary TB

9%
28%

42%

46% gap
88%

Diabetes 42%

53%
62%

Pneumonia
Diagnostic Accuracy

58% Acute Diarrhea 26%

45%

59%

Regional disparities
Diagnostic accuracy: competence Infrastructure availability
84% Kampala 65% 67% 56% 46% Central 55% 35%

Eastern

58%

Western

52%

Northern

45%

Northern

Western

Central

Eastern

Kampala

What providers do and know

UGANDA
All Absence from facility
Midwives

VS
Private 39% All 27%

KENYA
Public 29% Private 21%
82% 28%

Public 52%
48% 33%

46%

Midwives

Nurses

50% 35%

Nurses

72% 46%

Clinical Officer

75% 38%

Clinical Officers

81% 47%

Doctors

73% 48%

Doctors

86% 54%

Correct Diagnosis

Full Treatment

Correct Diagnostic

Full treatment

Health summary
Ugandan health facilities do well in terms of infrastructure and equipment but availability of drugs, especially for mothers, is a challenge Absenteeism of health providers is a cause for concern, and is more serious in public facilities 1 out of 10 health providers did not manage to diagnose any of 5 conditions. A correct diagnosis is no guarantee for full treatment, the knowledge gap is large There are large regional disparities in equipment, infrastructure, and providers competence

21

Conclusion
Uganda has made tremendous progress in access to basic education and health services but there are serious quality issues to be addressed Addressing quality of education and health services is crucial if Uganda is to build the healthy and educated workforce necessary to achieve Vision 2040 Improving quality will also ensure value for money by increasing efficiency and effectiveness of services Improving quality will require better management, a focus on providers incentives, and enhanced accountability

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Education and Health Services in

UGANDA
Data for Results and Accountability
NOVEMBER 2013