Managing the health sector and health workers, in part, involves the practical realities of managing a payroll and ensuring there are enough funds to pay everyone who is working and supporting the recruitment of open positions. In Uganda, the health sector has struggled with budget surpluses in some areas but shortfalls in others. Recognizing these challenges, earlier this week the Uganda Ministry of Finance met with the chief administrative officers, personnel officers, and chief finance officers in a first-of-its-kind, one-day meeting aimed at figuring out how to get the most accurate budget information from districts and avoid the problems of over- and under-budgeting.

Most often, budget shortfalls result from:

• A lack of up-to-date information about the current staff and salary needs when the budget is being developed
• Recruitment of new employees during the year that was not accounted for in the original budget
• Salary increases during the year that were not figured into the budget.

In Uganda, even as some areas of the health sector come up short on funding, others simultaneously report surpluses, which can result from:

• Failure to fill or delays in filling open positions which were budgeted for
• Inaccurate or out-of-date payroll records, leading to delays in salary payouts.

The realities of the difficulties in payroll management in the health sector can make it difficult to advocate for budget growth and may feed a perception that this sector is unreliable in paying its employees regularly, as compared to other sectors like education, making recruitment even more challenging.

The Uganda Capacity Program has been working with the wage management department at the Ministry of Public Service to find ways to appropriately and accurately manage the salaries of public service employees, particularly those in the health sector. One of the essential actions in managing salaries is quickly detecting when salary budget lines are over- or under-spent so that adjustments can be made before it is too late.

Last month, in an effort to assess how districts were doing in terms of their salary budgets, the Ministry of Public Service sent four teams to work with staff in 20 districts on budgeting concerns. Each of the teams was composed of staff from the Ministry of Public Service, the Ministry of Health, and the Uganda Capacity Program, and each team aimed to:

• Provide timely and accurate information on the magnitude of wage shortfalls/surpluses to inform wage reallocations before the close of the financial year
• Document the causes of wage bill shortfalls/surpluses
• Build capacity and a culture of systematic wage monitoring.

For example, in the Mubende District, the team found a budget surplus of 275,900,696 UGX (approximately 115,000 USD). If such a wage surplus had been detected earlier in the budget cycle, it could have been used to recruit more health workers and improve service delivery. Following this initial examination, the Uganda Capacity Program is continuing to collaborate with the Ministry of Public Service and the Ministry of Health to help the 42 districts with budget surpluses effectively use these funds by developing timelines to recruit new health workers that detail the process for advertising the position, short-listing candidates, hiring, and training new workers in a way that allows as many positions to be filled by the end of the fiscal year. The program is also collaborating with ministry staff to help the numerous districts that were facing shortfalls to make timely submissions for supplementary budgets needed to pay workers.