Annex A-USAID MOH Fleet Management Assessment Report.pdf

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FLEET MANAGEMENT ASSESSEMNT OF THE GOVERNMENT OF UGANDA’S MINISTRY OF HEALTH

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Fleet Management Assessment | April 2020

Final Assessment Report

REQ-617-19-000071

This report is intended solely for the information and internal use of USAID and its partners, and should not be used or relied upon by any other person or entity.

April 21, 2020

Contracting Officer – USAID/Uganda

Office of Acquisition and Assistance - US Mission Compound, South Wing

Plot 1577 Ggaba Road

Kampala, Uganda

Attention: Admir Serifovic

RE: Fleet Management Assessment of the Government of Uganda’s Ministry of Health

Deloitte (Uganda) Limited (hereafter referred to as ‘Deloitte’, ‘We’, ‘Us’) is pleased to submit the final report for the Fleet Management Assessment for the Ministry of Health.

The purpose of the assessment was to assist the Government of Uganda’s Ministry of Health to assess the current policies, systems and practices for managing its fleet.

In line with our reporting obligations, the report covers assessment of six areas, that is; Fleet mission, organization and responsibilities; Asset management; Fuel management; Fleet maintenance; Management

Information, dashboards and other tracking systems; and Fleet reform, change management initiatives and champions.

We appreciate the opportunity USAID gave Deloitte to support this important initiative, and trust that the contents of this report meet your requirements. If you have any questions concerning our report, please contact Stella Katumba at skatumba@deloitte.com or the undersigned at +256 414 343850 or via email at mndawula@deloitte.com.

Sincerely, On behalf of Deloitte (Uganda) Limited

Mabel Ndawula

Director

Deloitte (Uganda) Limited

3rd Floor, Rwenzori House

1 Lumumba Avenue

P.O. Box 10314

Kampala Uganda

Tel: +256 (417) 701 000

+256 (414) 343 850

+256 (312) 230 300

Fax: +256 (414) 343 887

+256 (414) 259 355

E-mail: admin@deloitte.co.ug www.deloitte.com

TABLE OF CONTENTS

1. EXECUTIVE SUMMARY

2. BACKGROUND AND INTRODUCTION

2.1 Background

2.2 Project objectives and scope of work

2.3 Assessment methods

3. ASSESSMENT APPROACH AND METHODOLOGY

3.1 Assessment framework

3.2 Assessment approach

4. KEY FINDINGS AND RECOMMENDATIONS

4.1 Status of implementation of Recommendations from MoH Fleet Analysis Report (FAR)

4.2 Fleet Mission, Organization and Responsibilities

4.3 Asset Management

4.4 Fuel Management

4.5 Fleet Maintenance

4.6 Management Information Systems, Dashboards and Other Tracking Systems

4.7 Fleet reform, change management initiatives and champions

5. CONCLUSION

5.1 Conclusion

5.2 Next steps

1. Fleet Mission, Organization and Responsibilities

ANNEX 1: LIST OF DOCUMENTS REVIEWED

ANNEX 1I: GETTING TO THE ANSWERS - DATA COLLECTION TOOL

ANNEX III: LIST OF STAKEHOLDERS INTERVIEWED

ANNEX IV: STATUS OF IMPLEMENTATTION OF FINDINGS FROM THE FAR 2017

ANNEX V: MoH VEHICLE DATABASE

Annex VI: ANNEX VI: STATISTICS DERIVED FROM THE MoH VEHICLE DATABASE

LIST OF TABLES

Table 1: Status of implementation of March 2017 recommendations

Table 2: Allocation of MoH HQ vehicles

Table 3: Vehicle allocation as a factor of the population in selected districts

Table 4: Key policy and responsibility aspects highlighted in existing government guidelines relating to fleet management

Table 5: Analysis of MoH fleet by mileage and age

Table 6: Current structure of MoH vehicle register

Table 7: Critical information to be captured in Vehicle register

Table 8: Cost benefit analysis of MoH in-house service bay vs. prequalified service provider charges for

'Service C' per vehicle

Table 9: Budget for Maintenance of vehicles FY 2019 – 2020

Table 10: Composition of vehicles by type and brand

Table 11: Components of a FMIS

Table 12: Comparison of FMS to other providers

Table 13: Requirements shared with MoH

LIST OF FIGURES

Figure 1: Assessment Approach

Figure 2: Proposed organizational structure at the Ministry of Health

Figure 3: District fleet management findings

Figure 4: Relationship between MoH and district in vehicle management

Figure 5: Components of a successful FMIS

Figure 6: Leading best practice

Figure 7: Comparison of prices from different FMS providers

Figure 8: Suite of fleet management solutions

Figure 9: Proposed management approach

Figure 10: Categories of change champions

ACRONYMS

Acronym Definition

CAO Chief Administrative Officer

DHO District Health Officer

FAR Fleet Analysis Report

FMIS Fleet Management Information System

GHG Green House Gases

GSM Global System for Mobile communications

GoU Government of Uganda

HoD Head of Department

HQ Headquarters

JICA Japan International Cooperation Agency

LG Local Government

MDA Ministries, Departments and Agencies

MoH Ministry of Health

MoFPED Ministry of Finance, Planning and Economic Development

MoPS Ministry of Public Service

MoU Memorandum of Understanding

MoWT Ministry of Water and Transport

MPS Ministerial Policy Statement

NDP National Development Plan

NITA - U National Information Technology Authority – Uganda

OAA Office of Acquisition and Assistance

OAG Office of the Auditor General

PDU Procurement and Disposal Unit

PIN Personal Identification Number

PPDA Public Procurement and Disposal of public assets Authority

PS Permanent Secretary

PSSO Public Service Standing Orders

RFID Radio Frequency Identification

SOW Statement Of Works

TO Transport Officer

UGX Uganda shillings

UIA Uganda Insurers Association

URMCHIP Uganda Reproductive Maternal and Child Health services Improvement Project

USAID United States Agency for International Development

VIN Vehicle Identification Number

Final Assessment Report

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1. EXECUTIVE SUMMARY

The objective of the Fleet Management Assessment is to assist the Government of Uganda’s (GoU)

Ministry of Health (MoH) to assess the current policies, systems and practices for managing its fleet. The activity is intended to assist MoH to improve its performance and accountability in delivering health sector results by resolving key management issues that undermine its credibility. One of the management issues identified was how effectively the Ministry of Health is using its fleet of vehicles to support the delivery of health care services to the citizens of Uganda.

This report focuses on six key assessment areas that were examined, and highlights recommendations necessary to strengthen MoH’s fleet management. The areas assessed were: Fleet mission, organization and responsibilities; Asset management; Fuel management; Fleet maintenance; Management Information, dashboards and other tracking systems; and Fleet reform, change management initiatives and champions.

The report categorizes and reviews evidence from desk reviews, field visits, observations and interviews with key stakeholders, further informed by technical experts across all six areas. The assessment questions and methods were formulated through a preliminary stakeholder analysis across players in both the public and private sector and a preliminary review of various MoH documents and reports. The assessment was conducted primarily through document reviews, followed by Key Informant Interviews

(KIIs), and site/facility visits to selected districts (i.e. Kampala, Wakiso, Jinja, Mbale, Gulu and Mbarara), National and Regional Referral Hospitals and Private-Not For-Profit health facilities.

In assessing MoH’s fleet mission, organization and responsibilities the team focused on assessing: i) the extent to which MoH management staff share a sense of mission and strategic direction ii) adequacy of organizational strategies, plans and budgets for all fleet management, iii) the extent to which organizational structures support safe, efficient, GoU-compliant, customer service-oriented, and accountable performance; and facilitate the vertical and horizontal linkages required for an integrated fleet management system, iv) presence of organizational policies, procedures and guidelines to support safe, efficient GoU-compliant, customer service-oriented, and accountable performance in fleet management and service delivery and lastly, v) extent to which human resource management policies and practices provide the professional development, supervision and motivation required to recruit and maintain a qualified staff.

The team found that limited accountability structures, siloed planning and budgeting and inefficient human resources all significantly affect the effectiveness of MoH’s fleet in service delivery. Involvement of technical fleet experts, centralization of budgeting and planning for fleet would be a great start to appropriating available resources and effective planning for use in health service delivery.

While the Government of Uganda (GoU) has clearly documented asset management policies, guidelines and procedures on asset acquisition, management and disposal, they are not dutifully followed resulting in gaps in the end to end process of allocation, management and disposal of assets. One of the recommendations from the 2017 assessment was that all vehicles should maintain log books to be populated by drivers for every trip taken. While this practice has worked well with the Uganda

Reproductive Maternal and Child Health services Improvement Project (URMCHIIP) and Japan

Status of the recommendations from

2017 Fleet management Assessment:

Our team reviewed the progress that has been made by MoH on the recommendations that were made in the March 2017 Fleet

Assessment Report and found that over 70% of the recommendations had not yet been implemented as a result of the weak structures which do not allow for accountability.

It is clear that if any progress is to be made on these recommendations, MoH must put in place change champions with the power to hold accountable non-compliant officers. There is also need for collaboration with other

Ministries and Department Agencies (MDAs) to implement some of the recommendations made

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International Cooperation Agency (JICA) program vehicles, there was little evidence that other vehicles held at the Ministry headquarters are implementing this recommendation.

Fuel management has for a long time been a major challenge for Ministry of Health. Currently, each department budgets for their respective fuel needs and fuel cards allocated by the departments to individual officers within the department rather than assigned to vehicles. The transport office coordinates fuel refills with the single service provider, VIVO Energy Limited. Department heads instruct the transport officer on how much fuel to allocate to the respective cards held within the department.

The assessment team did not see any form of accountability controls (such as fuel use tracking to specific official activities being implemented) in place to mitigate abuse of fuel cards. This makes it difficult for department heads or the transport office to assess if fuel is used for official work or not. It would be more efficient for fuel cards to only be allocated to MoH registered cars. Implementing a “one card per vehicle” policy will be useful in tracking fuel usage and increase accountability. Regular collection and analyzing of fuel usage data instead of relying on departmental annual planned activities will inform future budgeting at MoH.

In 2019, MoH to set up an in-house garage to handle preventative maintenance and minor repairs for

MoH vehicles attached to the MoH’s headquarters, which has resulted in savings of up to 33% on a basic regular service charge of vehicles at MoH. More complex repairs are still being outsourced to pre-qualified garages following pre assessment approvals from the Ministry of Works and Transport

(MoWT). Key informants highlighted that this process is cumbersome and there are instances where the quality of service received from the garages is not up to par. They also mentioned that the process of obtaining approvals from MoWT for repairs also creates a lag in turnaround time and leads to longer vehicle downtimes. However, there was no indication of delays in pre/post repair approvals from our discussion and review of approval records at MoWT. Consideration should be given to scaling this initiative to more complex repairs as well as to other MoH fleet deployed across the country through regional service bays in order to realize additional savings in the maintenance of fleet. The skills of the mechanics providing services in the in-house garage should also be built to handle more complex maintenance support for MoH vehicles.

Although efforts have been put in place by MoH to manage usage of vehicles through Head of

Department (HoD) approvals, logging of journeys, gate passes etc., there is still misuse of vehicles. As the custodian of health service delivery, it is important for MoH to maintain sight of its district fleet and ensure that vehicles are utilized for the Ministry’s objectives. Across the five assessment areas discussed so far, it is clear that implementation of a computerized Fleet Management Information System (FMIS) will play a critical role in supporting MoH to effectively plan and use their existing fleet for health service delivery. Cognizant of the fact that these systems are normally quite costly, MoH can launch the system in a phased approach, prioritizing areas that need immediate attention (e.g. fuel management, vehicle maintenance, vehicle downtime). The FMIS will need to be in tandem with other planned Ministries, Departments and Agencies (MDAs)/nationwide initiatives, for example, “Implementation of a Government-wide computerized motor vehicle fleet operation and maintenance management System (CMVSMS, 2019)”, by the MoWT in order to avoid duplication of efforts and resistance from other MDAs. MoH should also consider the support and economies of scale arising from using cloud hosting and other IT initiatives being provided by National Information Technology Authority – Uganda (NITA-U) as they finalise user requirements for the FMIS. In order to fastrack this system implementation, MOH should consider requesting an Exception approval letter from MoWT & NITA-U with guidelines on technology compatibility issues to ensure FMIS inter-operability with proposed national system.

Implementation of the recommendations made in this report will require MoH to develop a comprehensive change management strategy in consultation with all key stakeholders in both the public and private sector to ensure buy-in, avoid duplication of efforts and result in a long lasting solution to the fleet management challenge the Ministry is currently facing.

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2. BACKGROUND AND INTRODUCTION

2.1 Background

GoU is committed to health sector reforms to meet the ever-increasing population and healthcare needs of the country. The Government of Uganda through Ministry of Health is mandated to deliver health services to all Ugandans through a fleet of almost 4,000 vehicles deployed across Uganda. In 2017, MoH conducted a fleet assessment to establish the status of fleet management within the Ministry of Health, which highlighted a number of challenges currently facing fleet within MoH, including misallocation and misuse of vehicles, excessive levels of vehicle down time and high costs of fuel and vehicle maintenance.

In MoH’s Strategy for Improving Health Service Delivery (2016-2021), the Ministry of Health laid down three key strategic fleet management intents:

1. Ministry of Health shall introduce a vehicle tracker system to monitor movement of vehicles for control of fuel consumption and minimize on false fuel accountabilities.

2. Ministry of Health shall procure and prequalify at most three competent garages through framework contracts and a competent officer shall be in-charge of all Ministry of Health vehicle repairs.

3. The transport officer shall enforce use of Log Books and a tracking system to manage fleet movement.

The 2017 Fleet Analysis assessment that was carried out by the Ministry of Health further highlighted gaps in the way in which fleet is managed in the three strategic areas above. In order to drive towards implementation of the prioritized Health sector initiatives in relation to fleet, MoH requested USAID’s support in finding a lasting fleet management solution.

2.2 Project objectives and scope of work

The primary purpose of this activity is to conduct an assessment of Ministry of Health’s fleet management activities. This activity focuses on the key elements of a successful fleet management system and will allow MoH to implement the critical reforms that will enable the Ministry to effectively use its fleet to improve service delivery to the citizens of Uganda.

Fleet Mission, Organization and responsibilities: The MoH follows a number of policies and guidelines for fleet management and structures to support compliance. During this assessment, we sought to understand the existing reporting and accountability structures that exist within the Transport department at MoH headquarters and at the district level and ascertain the extent to which they are supporting the efficient use of the available fleet.

Asset management: This is an area where MoH is struggling significantly. Often, siloed management of fleet at national and district levels and inefficiencies in systems (complex, slow, unintuitive) leave staff less inclined to adhere to the processes necessary for organized fleet management. The assessment questions and data collection methods used by the assessment team were formulated considering a preliminary stakeholder analysis across Uganda’s health care system and a preliminary review of various

MoH documents and reports, including the Annual Health Sector Performance Report 2017/18, the

MoH Fleet Analysis Report 2017, Strategy for Improving Health Service Delivery 2016-2021,Vision 2040, the Uganda Public Service Standing Orders (November 2015), Treasury Instructions 2017, Ministry of

Works and Transport - 15th Joint Transport Sector Review 2019, Technical Report for Supply, Installation and Configuration of Fleet Management System for Ministry of Health Vehicles 2019, among others. The assessment questions for each assessment area are presented in Annex II of this report, MoH Fleet Management Assessment Page 7 titled: “Getting to the answers – data collection tool” while the assessment methods are presented in

Section 2.3: Assessment Methods

Fuel management: Fuel management has been an on-going challenge within MoH. Currently, fuel management is coordinated through the office of the Transport Officer (TO). The ministry issues fuel cards through a framework contract that was signed with Shell (Vivo Energy) Uganda to particular vehicles and directorates. Fuel cards are loaded with pre-determined amounts for fuel as instructed by the Heads of Department. However, there was insufficient evidence to show that there are sufficient controls in the fuel management process, as the majority of Ministry vehicles are neither calibrated nor tracked. Our assessment focused on understanding the fuel management process and identifying where the gaps are that result in the gross misuse

Fleet maintenance: MoH has been running an in-house vehicle maintenance workshop since 2019 and all fleet at MoH headquarters are serviced at this workshop. The assessment considered the current fleet maintenance recording practices, repair work order process and service tracking system for efficiency in line with best practices, in order to recommend areas of improvement to MoH.

Management Information, Dashboards and Other Tracking Systems: MoH, with technical support from Fleet Monitoring Systems (FMS) Africa, is implementing a number of reforms to improve fleet management including:

• A ‘pilot’ project tracking 70 vehicles using ZonMax which is a system that was implemented by Fleet

Monitoring Systems Africa initially for the measles / rubella vaccination campaign and is being fully-funded by the World Health Organization (WHO). We were not able to obtain information on the specific cost and terms of contract from WHO. All 70 vehicles have been calibrated and the system tracks live car location, battery status (in power or out of power) and fuel tank capacity. The system, however, relies on the signal quality generated from the vehicle and therefore requires a

Global System for Mobile communications (GSM) Signal Quality of at least 50% to provide accurate live location information. Each car’s key is attached in the system to a particular driver, but this is not trackable. For instance, if a driver hands the car to another person, the system cannot track this.

The funding (from WHO) for this particular system is expected to be phased out in 2020 and therefore the MoH will need to assess the value that this system has contributed to its fleet management and begin to make plans for its sustainability post funding. At the time of our assessment, accountabilities and system value for money reports were not available for us to make an informed assessment of the system.

• While the in-house workshop being run by MoH’s transport office has no budgetary vote, each department’s budget is expected to allocate about 30% of their budget to the transport requirements, with 20% covering fuel costs and 10% for maintenance. The aggregate amount from the respective departments is what the transport office uses for its activities.

Our team assessed the efficiency and nature of information currently collected from WHO funded

‘pilot’ project to establish whether the MoH team is able to use it for tracking driver performance, vehicle use efficiency and allocation. We found that despite the fact that each car’s key is attached in the system to a particular driver, this cannot be tracked making it difficult to measure driver performance.

The system however provides other critical information such as fuel tank capacity, battery status and live car location.

Fleet reform change management initiatives and champions: It is anticipated that this change will be met with some resistance, but it can be overcome if MoH identifies institutional change champions and gives them the support and resources to properly communicate the incentives for making these improvements. Dynamics between national and district-based resources will be a keen area of focus, as efficiencies cannot be achieved if there is fragmented and uncoordinated deployment and disposal of ministry fleet. The assessment team worked with the respondents to identify potential pockets of resistance and solicited their opinions regarding incentives that can motivate and sustain the

MoH Fleet Management Assessment Page 8 change. The assessment also sought to identify the key structural changes and staff skills that need to be enhanced for fleet management reforms to last.

Statement of Works (SOW): Following the assessment of the above six key areas, the Deloitte team will draft a Statement of Works that will describe the following;

i) Context in which the Contractor will be operating, including a summary profile of the fleet management system.

ii) Key objectives for the change management process.

iii) The technical assistance and professional development requirements for implementing change consistent with the recommendations agreed upon at the conclusion of the assessment.

iv) Position descriptions and qualifications for the key personnel recommended to satisfactorily meet the requirements of the SOW.

v) Instructions to bidders, based on guidance provided by USAID Office of Acquisition and

Assistance (OAA), including requirements that bidders respond to technical requirements and propose a change management plan based on the Contractor’s political economy analysis.

vi) Selection criteria based on guidance provided by USAID OAA.

vii) An estimate of cost for implementation of the recommendations

2.3 Assessment methods

Our team utilized various methods while conducting the Fleet Management Assessment including:

document review, stakeholder’s analysis, key informant interviews (KIIs) and field visits. These methods are described in detailed below:

Document Review: The assessment team reviewed documents relevant to this activity as provided by

USAID, MoH, and other similar programs funded by development partners. We also reviewed existing best practice reports, Government Standing orders and circulars that have been used as guidelines for fleet management in MoH.

Stakeholders Analysis: Based on the document review and additional background research, the team developed a stakeholder list for this assessment, as presented in the Annex III: Stakeholder list.

Key Informant Interviews: This was the main data collection method. We designed draft questions that were used as a guide during the KIIs. Stakeholders were interviewed from five (5) categories that included: MoH leaders; other government departments and ministries; Associations and Civil Society

Organizations; private sector stakeholders and representatives of patient groups and customers.

Field Visits: MoH executes its mandate in partnership with Local Governments. In addition to meetings within Kampala, we used a combination of random and purposive sampling techniques to select four additional districts that have regional referral hospitals for the site visits where the teams interviewed political and technical leaders as well as customers at respective facilities. These districts included; Mbale, Mbarara, Gulu and Jinja. We also selected Wakiso district because it covers a wide catchment area for a number of health programs.

Within each district and where possible, we sought to engage: Chief Accounting Officer, Directors of

Regional Referral hospitals, District Mechanical Engineer and the District Health Officer (DHO) and documented detailed notes, were consolidated, analyzed and triangulated with data from other sources.

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3. ASSESSMENT APPROACH AND METHODOLOGY

3.1 Assessment framework

The assessment approach was designed to be flexible and robust enough to capture all the emerging realities across the different levels within the Ministry’s fleet management system. In developing the assessment approach, questions were formulated to enable us to identify the existing gaps and opportunities for MoH to enhance the effectiveness of its fleet. Questions were framed around the six key assessment areas: fleet mission, organization and responsibilities, asset management, fuel management, fleet maintenance, management information, dashboards and other tracking systems, fleet reform change management initiatives and champions. The assessment was conducted primarily through document reviews, followed by Key Informant Interviews (KIIs), visits to selected districts (i.e. Kampala, Wakiso, Jinja, Mbale, Gulu, and Mbarara), National Referral Hospitals (NRHs), Regional Referral Hospitals

(RRHs), and Private-For-Profit (PFP) and Private-Not For-Profit (PNFP) health facilities. See detailed stakeholder list under Annex III. Our assessment approach below highlights the process we undertook in executing this engagement with the aim to provide recommendations for lasting solutions to MoH’s fleet management problem.

3.2 Assessment approach

• Develop a preliminary understanding of MOH’s Fleet management system

• Identify and agree with USAID and MOH, the stakeholder list for the key informant interviews, focus group discussions, facility site visits and online surveys.

• Develop data collection tools and interview questionnaires.

• Schedule key informant interviews, focus group discussions and site visits.

• Document and submit the work plan/ project charter.

• Literature review of relevant reports and publications.

• Conduct key informant interviews with MOH management and staff.

• MOH management and staff

• USAID project management team

• Conduct key informant interviews

• Detailed review of fleet management system structures and MOH documents including policies and procedures.

INITIATE & PLAN 1

REPORTING 3 CURRENT

ASSESSMENT

• MOH assessment management team

• USAID assessment management team

• Focal persons / Heads of select affiliate organizations

• Perform a detailed review of current state of MOH’s fleet management system. Areas of focus will include:

Fleet mission, organization and responsibilities

Asset management Fuel management

Fleet maintenance

Management information, dashboards and other tracking systems Fleet reform change management initiatives

Identify change champions and incentive scheme

• Document and issue the first draft assessment report including the following key sections -

Methodology

Major findings Conclusions

Identified data gaps

Recommendation s

Relevant annexes

• Review of the first draft assessment report by

USAID/MOH.

• Address USAID/MOH review comments and issue the final draft assessment report.

• Draft Statement of Work

• MOH assessment management team

• USAID COR/Alternate

COR

HOW:

How we will do it

WHO

What we will need to do

WHAT

Figure 1: Assessment Approach

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4. KEY FINDINGS AND RECOMMENDATIONS

4.1 Status of implementation of Recommendations from MoH Fleet

Analysis Report (FAR)

In March 2017, the MoH issued a Fleet Analysis Report from an exercise that was conducted in a bid to analyze the overall status of the Ministry’s fleet. The report considered a selected sample of MoH’s fleet and generated a number of conclusions and recommendations which formed a starting point for our assessment. The table below shows a high-level dashboard of the status of MoH’s implementation of the recommendations from the March 2017 report.

No. Recommendation Status

1 Deploy a computerized fleet management system

2 Create a designated pool of vehicles (Re-organize vehicles for entitled officers and others staff, in line with existing Uganda Public Service Standing Orders (UPSSOs) and Cabinet

Minutes)

3 Create a functional vehicle allocation committee, in line with the UPSSOs 2010

4 Procurement and Disposal Organs prepare and implement disposal plans annually

5 Strictly adhere to “Establishment Notice No. 1 of 2003”s i.e. ensure that engine capacities comply with standards stipulated in the “Notice” The notice standardized engine capacities for vehicles procured and allocated to entitled and other officers.

6 Vehicle maintenance is centrally managed

7 Recruitment/allocation of drivers

8 Motivation/discipline of drivers

9 Refresher courses for drivers

Table 1: Status of implementation of March 2017 recommendations

Key: Implemented Partially implemented Not implemented

Our assessment found that over 70% of the recommendations that had been made in the Fleet Analysis

Report had not been implemented and sought to understand the reasons for the delayed implementation, details of which have been included in Appendix IV of this report.

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4.2 Fleet Mission, Organization and Responsibilities

4.2.1 Overview

Ministry of Health (MoH) currently has control and management of 253 vehicles at the Kampala

Headquarters catering to a multitude of departments, projects and personnel (See vehicle database or details on fleet and allocations). The MoH follows a number of policies and guidelines for fleet management, as outlined below:

1. Procurement: MoH follows guidelines as detailed by the Public Procurement and Disposal of

Public Assets Authority (PPDA) for procurement of motor vehicles.

2. Oversight and repair: Approval for specifications of motor vehicles for purchase are handled by the Ministry of Works and Transport (MoWT) following standing orders that are generated by the

Ministry of Finance, Planning and Economic Development (MoFPED) but managed under the

Ministry of Public Service MoPS.

3. Planning and budgeting: the different departments at MoH plan and budget for motor vehicle expenses, based primarily on the activities that the department plans to carry out. Similarly, district health offices prepare their budgets that are then incorporated into the Ministry’s overall budget.

4. Disposal: Motor vehicle disposal is coordinated by the Transport office and carried out following the guidelines of the Public Procurement and Disposal of Public Assets Authority (PPDA).

Following a fleet analysis carried out by the ministry in 2017 which highlighted key recommendations to improve fleet management, MoH has implemented some reforms in its fleet organizational structure.

The structure was enhanced to include two assistant engineering officers in charge of mechanical work and policy and / technical advisory respectively. The ministry also set-up an in-house service bay/garage that carries out minor repairs and servicing of its vehicles that operate at the MoH headquarters in

Kampala.

Through these reforms, the ministry has been able to offset some of the costs spent on servicing, maintenance and repair, since the in-house service bay provides a more affordable option compared to external workshops and service providers. Organizational structure enhancements have provided the ministry with essential policy and technical advisory relating to fleet management.

The reforms are limited in addressing key tenets of fleet management, such as; budgeting and planning deficiencies, clarity and effectiveness of accountability structures for ministry fleet as well as enhancing skillsets for fleet staff. These are further detailed in our findings, with accompanying recommendations.

4.2.2 Key Findings

1. Organizational structure

MoH departments currently control the planning, budgeting and utilization of vehicles, fuel and maintenances for the vehicles allocated to their specific departments or projects. Each department as a practice is expected to allocate up to 30% of their total budget to fuel and fleet maintenance for their respective departments. Planning is based on department project planned activities for the year without consideration of the condition of the fleet in their custody. We observed that the department teams do not have the necessary skills to plan for fleet usage incorporating critical planning elements such as the age of a vehicle, mileage, the terrain the vehicle may encounter, service and maintenance requirements.

Cognizant of these shortfalls, to address the apparent lack of skills for fleet management MoH is building a dedicated fleet management team under the Transport Office. This team comprises of the Transport

Officer (TO) who reports to a Principal Assistant Secretary (PAS), two Assistant Mechanical Engineering

Officers (Policy & Operational), two supporting Technicians (Electrical and Mechanical) as well as drivers report to the Transport Officer (see structure below).

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The proposed organization structure is currently operational and all positions are filled, but pending approval from MoH’s top management team. Except for the Transport Officer, all other positions in the

Transport office are not on the Government Payroll.

The staff indicated in the structure serve a total of approximately 623 staff at the Ministry. Their key roles include: Providing administrative support for staff transport, management of drivers and ensuring

Ministry fleet are serviced and maintained and ensuring that fuel cards allocated to departments are functional and that fleet always have fuel available whenever required.

We noted the following risks and challenges regarding the proposed organizational structure:

The Undersecretary position is currently vacant.

The Assistant Engineering Officer in charge of policy and advisory doubles as the USAID

Governance, Accountability, Participation and Performance (GAPP) Advisor under the USAID

GAPP Project, and is not on the Ministry’s payroll. The Officer provides key policy support to the Permanent Secretary and advises departments on specifications for fleet during procurement. It is not certain what MoH will do to fill the gap when the GAPP project comes to an end because he is currently paid by GAPP.

The service bay staff work in the Ministry’s new service bay. They are currently on six months local contracts managed by the MoH Human Resources department. Their contracts are expected to expire in June 2020.

Permanent Secretary

Undersecretary (Vacant)

Technicians (Electrical &

Mechanical)

Office attendant

Principal assistant secretary (PAS)

Drivers

Assistant Engineering officer (Mechanical)

In charge of service bay operations Technicians (Electrical &

Mechanical)

Assistant Engineering officer (Mechanical)

In charge of policy and advisory

Senior Assistant

Secretary (Transport officer

Figure 2: Proposed organizational structure at the Ministry of Health

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The October 2019 staff list at MoH obtained from the MoH Personnel office lists 69 drivers and one vehicle attendant. 20 positions for drivers are listed as ‘vacant’. We further noted that nearly all the departments at MoH have drivers as part of their structure with most of the drivers under the administration department. It is therefore not clear how the Transport department exercises performance supervision to drivers who are not accountable to them, yet the structure shows that they are supposed to be accountable to the Transport Officer.

District findings

Regarding fleet management specifically, the relationship between districts and the MoH is limited primarily to procurement, as illustrated below.

District and Regional Referral Hospitals (RRH) receive oversite from the MoH on vehicles donated for specific activities. However, there are no specific guidelines and policy mandates for the MoH to follow regarding district support and supervision. We noted the following findings:

Fleet in the districts is managed and supervised by the District Health Officer (DHO) while the

Executive Directors provide supervision for fleet in the district hospitals and regional referral hospitals.

Vehicle allocation to the districts is handled at the MoH headquarters and does not consider factors such as the geographical terrain of the district, population served, specific health service delivery needs and district financial resources;

None of the districts we visited had a comprehensive fleet management system in place.

2. Fleet management policies and standards

The MoH follows the Public Service Standing Orders (PSSOs) with regard to fleet management, as issued by the Ministry of Public Service. MoH also follows policies and guidelines for fleet management as set by the MoWT. These policies cater to aspects of procurement, fuel management, maintenance and servicing as well as disposal, but are not incorporated in any comprehensive fleet management policy at MoH or the district health offices.

Figure 3: District fleet management findings

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Staff in the existing fleet and transport management structure and departmental staff handling fleet activities do not work under a uniform and comprehensive fleet management structure. The lack of a policy to guide such a structure creates a number of challenges including potential for duplication of activities and roles as departments and staff work, budget and plan in silos, undefined roles, skill requirements and training for fleet staff and unclear channels for accountability and management of MoH fleet. Departmental budgets are approved and allocated centrally, but are not necessarily linked to the overall MoH activity plans. With the various departments acting independently of each other for fleet planning activities, technical fleet requirements may not be met or even considered.

However, there are avenues for the Ministry to seek best practices and benchmarks. For instance, the

National Medical Stores (NMS) and Uganda Revenue Authority (URA) implements a robust fleet management policy which, among other key aspects defines: Driver behavior and expectations as well as key performance indicators (KPIs) for fleet staff, planning and budgeting requirements incorporating servicing and maintenance plans, and clear accountability channels and mechanisms for rewarding and reprimanding fleet and transport staff.

3. Structure of vehicle allocation and management The MoH operates a decentralized approach for allocation and management of its vehicle fleet, with

Heads of Department (HoDs) and projects in charge of their assigned vehicles. These include pool and project vehicles1. At the district level, vehicles are managed by the District Health Officer (DHO) with maintenance support from District Mechanical Engineers. The MoH is not responsible for the vehicles once allocated to the districts and hospitals because these entities have their substantive Accounting

Officers. Currently, MoH has 253 vehicles across different locations (See Figure 2). Vehicles purchased by the donors are for a specific activity, therefore, their management remains under the control of the specific donor until the project is concluded and the vehicle is transferred to MoH. Donor-funded vehicles are then integrated into the MoH pool for use by all staff.

Vehicle allocation of MoH vehicles Number of vehicles

Physically verified by

Deloitte

1. Ministry of Health Headquarters 201 40

2. Vector Control Unit 4 4

3. Central Public Health Laboratory(CPHL) | Ministry of

Health (Butabika) 20 19

4. National Tuberculosis and Leprosy Programme (NTLP) 8 -

5. Unspecified locations 20 -

Total 253 63

Table 2: Allocation of MoH HQ vehicles

We physically verified 63 vehicles out of the 253. See Annex V: MOH Motor vehicle Database.

Even though day to day management of the vehicles is done by respective user departments/projects, the Transport Office plays a coordination role for the procurement, fueling and maintenance of the vehicles as instructed by the user departments. Procurement, similar to other government agencies is done following the Public Procurement and Disposals Act (PPDA) guidelines. HoDs lead budgeting and planning for their departmental fleet needs and District Health Officers submit fuel, maintenance and service budgets to MoH for consolidation.

1 Pool vehicles are ministry vehicles that are available for use by all staff at the hospital for health service delivery activities whereas project vehicles are allocated to the ministry by donors for specific project activities. Project vehicles are typically added to the pool after project activities have been concluded.

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MoH set up an in-house service bay in 2019 that caters for minor repairs and servicing at lower rates in comparison to external vendors. More particular and extensive repairs and maintenance are done at contracted garages following pre- and post-maintenance approvals from the Ministry of Works and

Transport (MoWT). The Ministry makes significant cost savings over a large fleet by using its In-house service bay. An in-house policy at the MoH mandates departments to allocate 10% of their budget to repairs and maintenance at the service bay. In the current financial year, the assessment found that only

12 out of 23 departments (52%) had allocated a budget for repair and maintenance. Furthermore, departments often under-budget, due to lack of knowledge, skills and experience in the scope of technical needs that vehicles might have, resulting in a higher expenditure budget over time (See more details in Section 4.4 Fleet maintenance).

Regarding vehicle allocation, we established that district planning and budgeting processes encounter similar challenges. No clear distinction is made between population size variations in districts when planning vehicle allocations. For instance, Mbale district with a population of 488,9602 had only one ambulance at the regional referral hospital and neighboring Sironko district with a much lower population of 242,4213 also had one ambulance allocated (See the table below for vehicle allocation in the sampled districts). Additionally, there appear to be frustration in vehicle maintenance and utilization of assigned government resources at district level. While DHOs are required to work with District

Mechanical Engineers from the MoWT, the DHOs reflected concerns about the slow turn-around time for repairs and servicing of vehicles which affects performance and service delivery.

Our findings from the districts also reveal, to a small extent of institutional collaboration between the districts and regional referral hospitals – particularly for management of emergency health services. We noted that some district health offices use ambulances from the regional referral hospitals to carry out emergency health service delivery. Hospitals are not equipped with vehicles for other tasks such as support supervision which are carried through the ministry by the district health office.

District Number of vehicles allocated to District health office

Comments / Notes

Wakiso 5 Fleet includes 3 Station Wagons and 2 Sports Utility Vehicles

(SUVs). All the vehicles are located at health facilities in the district.

Jinja 3 Only one driver at the District health office which hampers key activities such as support supervision.

Mbale 2 District health office also uses motorcycles as ambulances.

Gulu 4 Includes 2 ambulances, one of which is not functional.

Mbarara 0 Borrows vehicles from the education office. Work in the health department is run by motorcycles that were provided by The Global Alliance for Vaccines (GAVI), which provided motorcycles to health facilities to carry out immunization outreaches.

However, all health facilities (including the regional referral hospital) have ambulances.

Table 3: Vehicle allocation as a factor of the population in selected districts

2 Population data sourced from most recent census information at: https://www.ubos.org/wp-content/uploads/publications/2014CensusProfiles/MBALE.pdf 3 Population data sourced from most recent census information at: https://www.ubos.org/wp-content/uploads/publications/2014CensusProfiles/SIRONKO.pdf

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Districts reported difficulties in meeting support supervision targets and being able to access all the health facilities under their dockets. DHOs also highlighted challenges in providing emergency medical services as ambulances are not provided. Districts also indicated that finance allocation for maintenance and servicing of vehicles is often not aligned to the core needs of the district fleet. For example, according to the DHO in Mbale, the district received an annual allocation of four million Uganda shillings

(UGX 4,000,000) for maintenance and servicing of the district’s two vehicles. Comparatively, this amounts to approximately UGX 1,000,000 per quarter which is significantly lower than MOH’s average maintenance spend of UGX 2,600,000 per vehicle per year.

4. Accountability structures

Accountability for vehicle usage and management of fuel, repairs, servicing and maintenance is decentralized within the departments at MoH. Subsequently, the accountability for vehicle fleet is under the discretion of HoDs. Currently HoDs manage the allocation of fuel cards, which are assigned to individuals in the department and not specifically to official vehicles. Utilizing these fuel cards, the HoDs advise the Transport Office to allocate specific fuel amounts to the cards per the departmental budget.

The department staff are expected to account back to the heads of department for fuel utilized and not to an independent individual such as the Transport Officer.

MoH is in partnership with Vivo Energy (Shell affiliate in Uganda) to provide fuel. Vivo Energy provides two monthly reports; the utilization statement and invoice statement of the amount of fuel used by the vehicles, which are reconciled by the HoDs in their various departments. However, there are no clear accountability lines to reconcile fuel usage to actual fleet activity, actual routes driven or outcomes of official activity. Furthermore, due to the constrained resources, departments inevitably plan for fuel based on activities rather than a holistic allocation of funds to fleet needs; and as a result vehicle repairs, servicing and maintenance receive limited resources in comparison to fuel assignment, driven by the need to accomplish departmental activities.

The assessment team also noted that there is insufficient supervision of drivers. In this regard, no journey management, follow-up on completion of journey logs and vehicle usage in respect of activity objectives are conducted to ensure comprehensive accountability. Ample journey management would include key details such as determining optimum and cost-efficient routes for drivers and the most ideal driving times, reviewing driver journey logs for completeness and clarity, as well as collecting vehicle usage data.

In the districts and regional referral hospitals, fleet management is the responsibility of DHOs and hospital Executive Directors, respectively. While similar challenges around fuel management and driver supervision were noted, districts are only accountable to the MoH headquarters with regard to procurement. Once new vehicles are delivered to the Chief Administrative Officer (CAO) from MoH, there are no other lines of accountability at the MoH level.

We noted a policy flaw, which does not provide for continued supervision of vehicle and fleet management from the MoH headquarters to the districts.

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Figure 4: Relationship between MoH and district in vehicle management

5. Staff skills

MoH in an effort to ensure good quality drivers now recruits drivers through a standardized procedure following the Public Service standards.

Furthermore, to reduce the service and maintenance costs of the Ministry, the Transport Office was enhanced with Technical Engineers and technicians as recently as 2019. This move was done to enhance the technical fleet assessment and servicing needs of the in-house service bay, in addition to the collaboration with the MoWT for pre and post maintenance assessment for their vehicles that are serviced and repaired by contracted garages.

Nevertheless, whilst adequate skills exist at the MoH in-house garage in repair, maintenance and servicing, key skills in logistics, fleet management and planning as well as distribution activities are lacking, given MoH’s mandate of providing health care services and distribution of medicines…