UGANDAData for Results and Accountability

NOVEMBER 2013

Education and Health Services in

SOUTH AFRICA

2

SDI: An Africa-wide initiative

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

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Expenditure

Behavior

Value for Money, Quality, and Equity

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

6/10 P4 pupils cannot read

sentence at P2 level (Uwezo

2011)

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

6/10 P4 pupils cannot read

sentence at P2 level (Uwezo

2011)

SDI aims to shed light on behavior at service delivery units

Outcomes

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What does SDI measure?

Education Findings

Input availability

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Schools do well on infrastructure and equipment…

Uganda Public Private

Teaching equipment 94% 94% 95%

School infrastructure 55% 60% 40%

Pupil-teacher ratio 39 46 19

…except for textbooks

What teachers do

Uganda Public PrivateSchool absence rate 24% 27% 14%

Classroom absence rate 53% 57% 40%

Classroom teaching time

3h19m 2h58m 4h18m

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Teachers’ Effort Out of 100 Ugandan primary teachers …

Private school: 50% more instruction

Private school: 50% more instruction

What teachers know

• Teachers’ test scores • Minimum Knowledge

…. according to the Uganda SDI data, students performance is strongly enhanced

by teacher’s knowledge

Teachers score much lower on teaching skills

assessment

Teachers score much lower on teaching skills

assessment

Regional disparitiesStudents per class

Time spent teaching per day (minutes)

Northern classes 3 times

larger than Kampala’s

Northern classes 3 times

larger than Kampala’s

Northern students receive

2.5 times less teaching time

Northern students receive

2.5 times less teaching time

SDI: Uganda vs Kenya

What teachers do: absenteeism What teachers know: minimum knowledge

Education summary

• Ugandan primary schools do well in terms of infrastructure and equipment … but textbook use is a challenge

• Teacher’s 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

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Health Findings

Infrastructure Availability

Electricity Clean water Improved toilet Minimum infrastructureUganda 73% 93% 89% 64%

Drugs and equipment availabilityTracer drugs Mothers drugs Children drugs HC2 drugs Equipment

Uganda 79% 35% 49% 58% 83%

What health providers doUganda Private Public

Absence from facility 46% 39% 52%

Absence by location and facility type Reason for absence

What health providers knowA large gap between diagnostic and treatment

Regional disparities

Diagnostic accuracy: competence Infrastructure availability

What providers do and knowUGANDA KENYA

All Public Private All Public PrivateAbsence from facility 46% 52% 39% 27% 29% 21%

VS

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

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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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UGANDAData for Results and Accountability

NOVEMBER 2013

Education and Health Services in