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MINISTRY OF HEALTH
Prepared by:
2011
Table of Contents
4.0 Criteria for designation, establishment and upgrading of health facilities .,...............6
4.2 Criteria for Designation of Levels of Services Delivery of Health Units ........... ..........................6
5.0 Procedure for designation, establishment and upgrading of health facilities........ ..........................8
Over time, it has been observed that there is continued mismatch between health
infrastructure development and other resources such as personnel, equipment, medicines
and supplies across the country, This has resulted in inefficiency in investments and service
delivery in the sector. 0n the other hand, there have been several requests by districts and
other stakeholders for establishment of new facilities and upgrading of existing ones from
one level to another, Whereas the relevant criteria for health facilities development has
been stated or implied in the Health Sector Strategic and lnvestment Plan, the requests
indicate that it is not well articulated. lt has therefore become necessary to develop more
detailed guidelines for establishment of new facilities as well as upgrading existing ones,
These guidelines have been prepared by the Ministry of Health to enhance economy,
efficiency and effectiveness in infrastructure development and harmonise it with other inputs
to improve service delivery in the health sector. They are specifically aimed at providing
criteria and procedures for designating level of service and upgrading of health centres from
one level to another as well as establishing new ones. These guidelines and procedures
apply to both government and private-nolfor-profit facilities.
Another challenge has been the disagreements on the designation of levels of health
facilities between the different stakeholders, lt is therefore necessary that clear and more
Districts and other stakeholders intending to establish or upgrade health facilities are urged
to strictly adhere to these guidelines. No requests for creation or upgrading of facilities will
be considered or approved unless it meets the set criteria and has followed the procedures
-@',*g'-'r=
Dr, JaneHth Aceng
DIRECTOR GENERAL HEALTH SERVICES
GUIDELINES FOR DESIGNATION, ESTABLISHMENT AND UPGRADING OF HEALTH FACILITIES
walking distance to every homestead. Health lnfrastructure is composed of Buildings, Medical and hospital
equipment, Communicatian systems & equipment and Ambulance and franspor(a(rbn fac(tities.
Over the last 10 years of HSSP I & ll, many stakeholders including central and local governments, Non-
Government Organisation as well as communities have invested in health infrashucture development that
has resulted into an increase in the number of health facilities as demonstrated in Table 1 . lt has however
been noted that there has been a mismatch between investments in health lnfrastructure and other
components of the health services delivery which need to be harmonised.
This guideline is intended to provide the criteria for designation, upgrading and establishment of health
The main objective of these guidelines is to enhance economy, efficiency and effectiveness in infrastructure
development and harmonising it with other input for improved service delivery in the health sector. The
According to the Health Sector Strategic and lnvestment Plan (HSSIP), there is a mismatch between health
infrastructure and the health workforce across the country which has resulted in the inefficient use of these
two critical investments. lt has also been observed that accommodation for staff in existing facilities
remains a big challenge and is the major reason for low staff numbers. lnadequate or poor medical
equipment in existing facilities is also of great concern as many of the existing health facilities lack the
necessary equipment while only 40% of the available equipment is in good condition. There is therefore
need to rationalise health infrastructure investments to ensure that they effectively and efficiently contribute
Furthermore, the criteria for designation of level of service delivery to health centres in HSSPI was based
on administrative units whereby each parish was expected to have a HC ll; a HC lll for each sub-county, a
health centre lV for a health sub-district or county and hospital for each district, The plan also made
reference to population, but this was majorly for identifying administrative units which were densely
populated as to deserve more than one health centre of a particular level. The overriding principle for
establishment of new health centres was, and still remains, to provide health services to within 5 km
distance, The HSSP I assumed that by providing facilities by administrative units as indicated above, the
criteria for Skm walking distance would be achieved. However over the years, many of these
administrative units have been subdivided and reduced in size and population; as more and more districts
were created, Going by the HSSP I criteria would therefore result in an over investment.
On the other hand, there have been several requests by districts and other stakeholders for establishment
of new facilities and upgrading of existing facilities from one level to another. Whereas the relevant criteria
has been stated or implied in the Health Sector Strategic and lnvestment Plan, some of the requests seem
to indicate that it is not well understood and therefore the need for more detailed criteria to guide the
processes for establishment of new facilities as well as upgrading existing ones.
Another problem has been the disagreements on the designation of levels of health facilities between the
different stakeholders. There have been several incidences of disagreement on the levels assigned to
health centres between parties concerned with infrastructure, medicines and supplies as well as staffing;
the communities; the districts authorities and other government departments. lt is therefore necessary that
clear and more detailed guidelines are provided to avoid such contradictions in future.
- Consolidation of the existing facilities so that they can effectively deliver the services at their
- To ensure that new health units are located in those areas which are underserved and thereby
enable increased accessibility
service, have been identified as indicated in Table 2. The levels assigned to individual health centres in
the Ministry of Health Facilities' lnventory of May 2011 shall be maintained. The strategy thereafter should
be to consolidate the assigned level of service in accordance with the strategies of the HSSIP by providing
missing facilities as necessary. Designation of new levels of service delivery to health facilities, especially
to higher levels of services, shall follow the criteria for upgrading of health facilities outlined in these
guidelines,
their respective level especially due to lack of staff, staff houses and equipment. Consequently,
establishment of new facilities should be limited as this would further aggravate the problem of
inadequately facilitated health units, Notwithstanding the constraints, new facilities shall be established in
L Where a community of about 5,000 people is not in reach of a health unit within 5 km walking
facility in this case would be determined by survey and assessment on a case by case basis.
Factors to consider would include but not be limited to population of the community, distance to
health facilities of different levels and ease of attracting staff to work in the area,
levels of services require more of these inputs to function effectively. Any proposals to upgrade
(infrastructural or otherwise) of health facilities should therefore be properly planned with evidence of
resources to ensure that all the necessary inputs shall be available to avoid wasteful investments, ln this
regard, upgrading of health facilities shall only be recommended if the following criteria with regards to
4.4.1 lnfrastructurerequirements
1. The health centre should have all the medical buildings and equipment for the current level of service.
2. There should be at least 50% of staff houses' requirements of the current level of service.
3. There should be a clear plan for providing the additional infrastructure for the higher level anticipated
Table 3 shows the basic requirements for medical buildinqs and the 50% staff houses for Health Centre Il
to General Hospital. The Medical Equipment standard lists and standard buildinq ptans. by level, can be
obtained on request from the Health lnfrastructure Division, Ministrv of Health.
Table 3: Standard building infrastructure requirements by level of health unit
4.4.2 Staffingrequirements
To qualify for upgrading, the following criteria should be met:
1. The staffing at the health centre should be at least 65% of the core technical staff of the current level of
service
2. There should be a clear plan of how the additional staff for the upgraded level of services is scheduled
to be realised.
The staffinq norms for HC ll to General Hospital are annexed to these quidelines
The Constitution of Uganda (1995) and the Local Government Act (1997) mandate the Local governments
to plan, budget and implement health policies and health sector plans. Accordingly, provision of health
services in Uganda has been decentralised to districts and health sub-districts which play a key role in the
delivery and management of health services. These local governments manage public general hospitals
and health centres as well as supervising and monitoring all heatth activities including those in the private
sector. Local Governments therefore are well placed to determine the health facilities requirements in their
areas and identifying the needs for establishment of new health units and those that require upgrading.
However, the Ministry of Health Headquarters like all other national level institutions / departments has
retained, among others, the functions of resource mobilisation, policy formulation, setting standards and
quality assurance, ln light of this framework, the Ministry of Health has set out the following procedures in
Table 4 for authorisation of establishment of new and upgrading of existing health units intended to ensure
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Annexes
11
Annex 1: Application for establishment and upgrading of Heatth Facitities
12
MINISTRY OF HEALTH
1. Applicant:
Name
Request for:
(i) District:
(iii) Sub-county:
(iv) Parish:
East ..km
West ..km
South ,.km
13
North km
(vi) Specialgeographicalfeatures:
Parish
Sub-Countv
Health Sub-District
4. Plan for development and operational resources for the requested facility
Date:
I4
$gCTlON ll: EVAIUATI*hI ffiY T$"iF U$TRICT HilALTH TIAM ffo Se conrp!*fcd Sy Slsfrief *{e*/ffr
Offincrl
N.B: If approved, the request should be submifted to the District Councilthrough the standing committee on Health for
ratification
SfeTf*N lf l: AFFR*VAL 8Y TL{g [}|$TR!*T CSU$\$CIL {I* b* e*rwpleted &y f&e 0&fef
S dn: rn rs fra fi r'"c $ffire$
15
Annex 2: Staffing Norms for Health Centre Ilto General Hospital
16