2,r d1 / THE REPUBLIC OF UGANDA o be an e'ffective an hicient Supr/e AudAit lastitton (SA!) in prooting electivea public acconaility M SSON:To Audit and report to Parlnament and thereby ma.ke an effectivc contribution to impro'ving pAIDubl1itonfaiity m ue ortMoney Spen ' AYCRSPO /NDE NCE ON T 1S 1S 1 EASE QUOTE NO.. VFM 84/342/02 24th December, 2017 3 1 DEC 208 The Rt. Hon. Speaker of Parliament Parliament of Uganda Kampala REPORT OF THE AUDITOR GENERAL ON THE FINANCIAL STATEMENTS OF UGANDA REPRODUCTIVE HEALTH VOUCHER PROJECT GLOBAL PARTNERSHIP ON OUTPUT BASED AID GRANT NUMBER TF015995 FOR THE YEAR ENDED 30TH JUNE 2018 In accordance with Article 163, (4) of the Constitution of Uganda 1995 (as amended), I forward herewith audited Financial Statements of Uganda Reproductive Health Voucher Project Global Partnership on Output Based Aid Grant Number TF015995 for the financial year ended 30th June, 2018 to her with my report and opinion thereon. John F.S. Muwanga AUDITOR GENERAL Copy to: The Hon. Minister of Ethics and Integrity The Inspector General of Government The Permanent Secretary/Secretary to the Treasury Ministry of Finance, Planning and Economic Development The Permanent Secretary, Ministry of Health The Accountant General, Ministry of Finance, Planning and Economic Development The Head of Accounts, Ministry of Health Member of the international Organisation of Supreme Audit Institutions (INTOAI THE REPUBLIC OF UGANDA REPORT OF THE AUDITOR GENERAL ON THE FINANCIAL STATEMENTS OF UGANDA REPRODUCTIVE HEALTH VOUCHER PROJECT (URHVP) GPOBA GRANT NUMBER TF015995 FOR THE YEAR ENDED 30TH JUNE 2018 OFFICE OF THE AUDITOR GENERAL UGANDA LIST OF ACRONYMS Acronym Meaning GoU Government of Uganda INTOSAX International Organization of Supreme Audit Institutions ISSA International Standards on Auditing GPOBA Global Partnership on Output Based Aid URHVP Uganda Reproductive Health Voucher Project UHSSP Uganda Health System Strengthening Project PFMA Public Finance Management Act, 2015 UGX Uganda Shillings VSP Voucher Service Provider VMA Voucher Management Agent IVEA Independent verification agent MoH Ministry of Health TABLE OF CONTENTS LIST O F A CO N Y1M S ..................................................................................................................... REPORT OF THE AUDITOR GENERAL ON THE FINANCIAL STATEMENTS................... 3 OF UGANDA REPRODUCTIVE HEALTH VOUCHER PROJECT GLOBAL PARTNERSHIP ON OUTPUT BASED AID GRANT NUM BER TFO15995 ..............................................................................-......... 3 O p in io n ....... ........................ ...................................................... ............................................................. 3 B a sis o f O p in io n .......................................................................................................................... - . .3 Ke y A u d it M a tte rs ...................................................................... ...................................................4 O the r M a tte r..................... ............................................................................... ............................. . .-4 * Delays in paying the Independent Verification Agent (IVEA) and the Voucher M anagem ent Agent (VMA ). .................................................. . ............................................. -4 * Delays in processing and reimbursement of claims by the VMA....................................5 O the r Info rm ation............................................................................................................................. 5 Responsibilities of the Accounting Officer for the Financial Statements......................................6 Auditor's Responsibilities for the Audit of the Financial Statements.........................................tm6 O ther Reporting Responsisbiblites ..............................................................................i-s........... .. ..... 8 * Compliance with legislation and Regulations................................................................8 2 REPORT OF THE AUDITOR GENERAL ON THE FINANCIAL STATEMENTS OF UGANDA REPRODUCTIVE HEALTH VOUCHER PROJECT GLOBAL PARTNERSHIP ON OUTPUT BASED AID GRANT NUMBER TF015995 FOR THE YEAR ENDED 30T' JUNE 2018 THE RT. HON. SPEAKER OF PARLIAMENT REPORT ON THE FINANCIAL STATEMENTS Opinion I have audited the accompanying financial statements of Uganda Reproductive Health Voucher Project GPOBA Grant Number TF015995 for the year ended 30h June 2018. The Financial Statements comprise the Statement of Income and Expenditure for the Grant, Statement of Fund Balance for the Grant, Statement of Income and Expenditure UHSSP Contribution and significant accounting policies and other explanatory notes, schedules and annexes as set out on pages 13 to 28. In my opinion, the financial statements present fairly, in all material respects, the financial position (Fund Balance) of Uganda Reproductive Health Voucher Project as at 30th June 2018 and its income and expenditure for the year then ended in accordance with the Public Finance and Accountability Act 2015 and the basis of accounting described under Note 1.1 to the Financial Statements. Basis of Opinion I conducted my audit in accordance with International Standards of Supreme Audit Institutions (ISSAIs). My responsibilities under those standards are further described in the Auditor's Responsibilities for the Audit of the Financial Statement's section of my report. I am independent of the entity in accordance with the Constitution of the Republic of Uganda (1995) as amended, the National Audit Act, 2008, the International Ethics Standards Board for Accountants Code of Ethics for Professional Accountants (Parts A and B) (IESBA Code), the International Organization of Supreme Audit Institutions (INTOSAI) Code of Ethics and other independence requirements applicable to performing audits of Financial Statements in Uganda. I have fulfilled my other ethical responsibilities in accordance with the IESBA Code, and in accordance with other ethical requirements applicable to performing audits in Uganda. I In connection with my audit of the financial statements, my responsibility is to read the other information and, in doing so, consider whether the other information is materially consistent with the financial statements or my knowledge obtained in the audit, or otherwise appears to be materially misstated. If, based on the work I have performed, I conclude that there is a material misstatement of this other information; I am required to report that fact. I have nothing to report in this regard. Responsibilities of the Accounting Officer for the Financial Statements Under Article 164 of the Constitution of the Republic of Uganda, 1995 (as amended) and Section 45 of the Public Finance Management Act, 2015, the Accounting Officer is accountable to Parliament for the funds and resources of the Uganda Reproductive Health Voucher Project GPOBA Grant Number TF015995. The Accounting Officer is also responsible for the preparation of financial statements in accordance with the requirements of the Public Finance Management Act 2015, and the Financial Reporting Guide, 2018, and for such internal control as management determines is necessary to enable the preparation of financial statements that are free from material misstatements, whether due to fraud or error. In preparing the financial statements, the Accounting Officer is responsible for assessing the project's ability to continue delivering its objectives, disclosing, as applicable, matters related to affecting the delivery of the project development objective, and using the Financial Reporting Guide 2018 unless the Accounting Officer has a realistic alternative to the contrary, The Accounting Officer is responsible for overseeing the projects' financial reporting process. Auditor's Responsibilities for the Audit of the Financial Statements My objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor's report that includes my opinion. Reasonable assurance is a high level of assurance but is not a guarantee that an audit conducted in accordance with ISSAIs will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements. 6 As part of an audit in accordance with ISSAls, I exercise professional judgment and maintain professional skepticism throughout the audit. I also: * Identify and assess the risks of material misstatement of the financial statements, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control. * Obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the project's internal control, * Evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by management. * Conclude on the appropriateness of management's use of the going concern basis of accounting and, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast significant doubt on the project's ability to deliver its mandate. If I conclude that a material uncertainty exists, I am required to draw attention in my auditor's report to the related disclosures in the financial statements or, if such disclosures are inadequate, to modify my opinion. My conclusions are based on the audit evidence obtained up to the date of my auditor's report. However, future events or conditions may cause the Uganda Reproductive Health Voucher Project to fail to deliver its mandate. * Evaluate the overall presentation, structure and content of the financial statements, including the disclosures, and whether the financial statements represent the underlying transactions and events in a manner that achieves fair presentation. I communicate with the Accounting Officer regarding, among other matters, the planned scope and timing of the audit and significant audit findings, including any significant deficiencies in internal control that I identify during my audit. I also provide the Accounting Officer with a statement that I have complied with relevant ethical requirements regarding independence, and to communicate with him/her all relationships and other matters that may reasonably be thought to bear on my independence, and where applicable, related safeguards. 7 From the matters communicated with the Accounting Officer, I determine those matters that were of most. significance in the audit of the financial statements of the current period and are therefore the key audit matters. I describe these matters in my auditor's report unless law or regulation precludes public disclosure about the matter or when, in extremely rare circumstances, I determine that a matter should not be communicated in my report because the adverse consequences of doing so would reasonably be expected to outweigh the public interest benefits of such communication. Other Reporting Responsibilities * Compliance with legislation and Regulations In accordance with sections 19(1) of the National Audit Act, 2008, I report to you, based on my work described in the report on the Financial Statements that the activities, financial transactions and information reflected in the financial statements that have come to my notice during the audit, are in all material respects, in compliance with the authorities which govern them. John F.S. Muwanga AUDITOR GENERAL KAMPALA 24th December 2018 8 MINISTRY OF HEALTH Republic of Uganda UGANDA REPRODUCTIVE HEALTH VOUCHER PROJECT FINANCIAL STATEMENTS FOR THE FINANCIAL YEAR ENDED 30 JUNE 2018 AUGUST 2018 The Uganda Reproductive Health Voucher Project (URHVP) Financial St2rent%nts for 12 Months Ended 30 June 2018 Contents PRO JECT IN FO RM ATIO N .11................................................ ...................................... H 1.0 IN TR O D U C T ION.........................................._ .................................................... 1 1.1 PROJECT DEVELOPMENT OBJECTIVE.......................................................TIE 1 1.2 PROJECT BENEFICIARIES .............................NIAE............................................... 1 1.3 PROJECT COM PONENTS2................................................................................. 2 1.4 Roles and Responsibilities of the Principal Parties........................................-. 2 1.4.1 Ministry of Health/Inter-Agency Coordination Committee....m._mi................ 2 1.4.2 Marie Stopes Uganda (Voucher Management Agent).................................... 2 1.4 .3 S ervice Providers........................................................................................ 3 1.4.4 BDO East Africa (Independent Verification Evaluation Agent) ...................... 3 2.0 Management's Responsibility for the Financial Statements ...............................at 4 3.0 Project Progress Report and Financial Statements................................................ 5 3.1 Project Progress Report for the Financial Year ended 30 June 2018...................5 3.1.1 Provision of skilled delivery services.............................v..e..S.................... 5 3 .1.2 C apacity bu ild in g ................................................... .............................. 5 3.1.3 Claims processing re-imbursements and quality assurance......................... 6 3.2 Progress towards Outcom e Level..................................................... ............ 8 3.2.1 Number of vouchers sold and redeemed.................................................... 8 3.2.2 W omen attending at least one ANC visit...................................................... 8 3.2.3 Mothers attending Post-natal care services (PNC)......................................... 9 3.2.4 Pregnant wom en tested for HIV.............................................V.0 ................. 10 3.2.5 Strengthening referrals for emergency care and linkages between VSPs..... 10 3.2.6 M aternal Deaths registered................................................................ 11 3.2.7 Perinatal deaths/Fresh still births........................................................... 12 3.2.8 Reimbursement of service provider claims ............................................... 12 4.0 FINANCIAL STATEM ENTS.................................-- ............................................ 13 4.1 Statement of Income and Expenditure for the Grant..................................... 13 4.2 Statement of Fund Balance for the Grantrn.................................................. 14 4.3 Statement of Income and Expenditure UHSSP Contribution ........................... 15 5.0 Notes to the Financial Statem ents.................am.................................................... 16 6 .0 A n nexes ......exe.......................... ............................... . ....................... . 5 6 .1 A n n ex 1 .................. . .........5..... ........................ . ..................... 2 5 6 .2 A n n ex 2 ...............2 ............................. - . .7........ . _ ............ ....... _.. 2 7 Yea- 3 of the Project The Uganda Reproducthefleakdh Voucher Project (URHVP) Financial Stalenents for 12 Monthq Ended 30june 2018 PROJECT INFORMATION Project Implementer Ministry of Health Funding Source World Bank-IDA- Global Partnership on Output-Based Aid Project Number: TFO 15995 Grant Amount USD: 13.3 Million Bankers Bank of Uganda P.O. Box 7120 Kampala Road Account Name: Uganda Reproductive Health Voucher Project Account No: 000140088400034 USD Account Account No: 000140088000088 UShs Account Auditors Office of Auditor General Plot 2/4 Apollo Kaggwa Road P.O. Box 7083 Kampala - Uganda. Tel: +254 414 344 340 Email: info(c-,oag.g.ug Voucher Management Agent Marie Stopes Uganda Independent Verification and Evaluation Agent BDO East Africa Year 3 of the Project 1.0 INTRODUCTION Swedish International Development Agency (SIDA) through the Global Partnership on Output Based Aid (GPOBA) extended a Grant of United States Dollars 13.3 Million to the Republic of Uganda to deliver the Uganda Reproductive Health Voucher Project. The Rationale for financing was based on poor women in Uganda face several challenges with accessing safe delivery services. The majority reside in rural areas where safe delivery services in general are inadequate. In addition to geographical barriers, the poor women also face significant financial barriers. Whereas services offered by public facilities are meant to be free, owing to recurrent shortages of drugs and supplies, the patients are usually required to buy the various commodities. The targeting of subsidies will reduce financial barriers to care and promote demand and access to services that reduce risks associated with pregnancy and child birth for poor women. 1.1 PROJECT DEVELOPMENT OBJECTIVE The project development objective is to increase access to skilled care among poor women living in rural and disadvantaged areas during pregnancy and delivery. 1.2 PROJECT BENEFICIARIES The primary beneficiaries are the poor and vulnerable pregnant women resident within the catchment areas of the contracted health facilities in the Eastern and South Western Uganda. The mothers are expected to be able to reach the facilities in less than two hours. The contracted service providers and surrounding communities are the secondary beneficiaries. 1 Year 3 of the Project The Ugnda Reprodaucive Health Voucher Project (URIHVP) Financial Statements for 12 Months Ended 30 June 2018 1.3 PROJECT COMPONENTS a) Package of safe delivery services to poor pregnant women (USD: 9.5 Million) This component is to provide 132,400 pregnant women access to a defined package of safe delivery services from contracted private and public providers. The package of services consists of: four antenatal visits, safe delivery, one postnatal visit, treatment and management b) Capacity Building and Project Management (USD: 3.8 Million) This component is to support project management functions and build national capacity to mainstream and scale up implementation of the safe delivery voucher scheme in the health sector. 1.4 Roles and Responsibilities of the Principal Parties 1.4.1 Ministry of Health/Inter-Agency Coordination Committee a) Policy and overall coordination; b) Strategic guidance and oversight, and act as an advisor to key stakeholders, including the MoH, contributing HDPs, VMA & service providers c) Oversee the development of operational manual and changes thereto; d) Approval of mechanisms to appoint the VMA and IVEA. e) Review and endorse annual work plans and budgets, progress reports, financial statements, withdrawal applications, and overall performance 1.4.2 Marie Stopes Uganda (Voucher Management Agent) a) Implement and manage the Project in line with the Operational Manual and strive to increase the efficiency and effectiveness of its management systems. b) Design and produce security-coded vouchers which are difficult to forge. c) Distribute vouchers to the target population. d) Select, train and contract services providers to give the agreed services. 2 Yer 3 of the Project The Uganda Reproductive Health Voucher Project (URHVP) PnaTcial Statements for 12 Months Ended 30 June 2018 e) Implement an efficient and fraud detection enabled claims processing system. 1.4.3 Service Providers a) Provide the services as described in the Treatment Guidelines and the Operational Manual b) Treat clients with respect and dignity and to strive to improve the quality of care. c) Allow the VMA and the IVEA full access to the facility, records and staff 1.4.4 BDO East Africa (Independent Verification Evaluation Agent) a) Provide external monitoring of the project at 6 monthly intervals b) Verify whether clients received claimed services; assess the quality of service provision, voucher distribution and BCC and training activities. c) Assess the claims processing, payment and fraud control systems of VMA. d) Report every 3 months to MoH, ICC and Development Partners on the project Implementation 3 Year 3 of the Project The Uganda Reproducdve Health Voucher Project (UREV) Financial Stacmncts for 12 MonthsEndcd 30 June 2018 2.0 Management's Responsibility for the Financial Statements Management of Ministry of Health is responsible for preparing the Project Financial Statements, which give a true and fair view of the state of affairs of the project, as at the end of the accounting period. This responsibility includes: Selecting, applying and maintaining adequate and appropriate Financial Management Systems and Policies, and ensure that these continue to be effective throughout the reporting period; and making accounting estimates that are reasonable in the circumstances. Maintaining proper accounting records, which disclose with reasonable accuracy at any time, the Financial Performance of the Program; designing; implementing and maintaining Internal Controls relevant to the preparation and fair presentation of the Financial Statements and ensuring that they are free from material misstatements, whether due to fraud or error. They further ensure that they comply with the GoU and World Bank Financial Regulations and Audit guidelines, and safeguarding the assets of the Project. Ministry of Health Management accepts responsibility for the Project Financial Statements, which have been prepared on the Cash Basis method of Financial Reporting, using appropriate accounting policies in accordance with the International Public Sector Accounting Standards (IPSAS). PERMANENT SECRETARY ASSISTANT COMMISSIONER/ACCOUNTS MINISTRY OF HEALTH MINISTRY OF HEALTH PROJECT COOWNATOR MINISTRY OF HEALTH 4 Year 3 of the Project The Uganda Repmductive Helth Voucher Project (URHVP) Fiancial Statenents for 12 Months Ended 30 June 2018 3.0 Project Progress Report and Financial Statements 3.1 Project Progress Report for the Financial Year ended 30 June 2018 The Project was in the 3 year of its implementation financial year 2017/18. The period was one of full scale delivery of maternity services, including Post-Partum Family Planning (PPFP). 3.1.1 Provision of skilled delivery services Over the past 12 months, 90,299 vouchers were distributed. This resulted in 57,832 deliveries; representing a 64% redemption rate. Out of these, 48,038 (83%) were normal, 983 (17%) Caesarian section and 40 (less than 1%) were assisted deliveries. 75,563 (84%) women received ANCI services and 22,420 (39%) women received PNC. Out of the women who delivered in PY3, 14,975 (26%) received Post-partum family planning translating into 47,520 CYPs, 3.1.2 Capacity building 438 service providers from 212 contracted facilities were mentored on the management of Post-partum hemorrhage (PPH), the provision of on Post-Partum Family planning (PPFP), with a focus on Long Acting Reversible Contraception methods (LARC) and the management of side effects. Maternal and Perinatal Deaths; during the period, URHVP registered twelve (12) maternal deaths. The majority (60%) of the deaths werc due to Hemorrhage and in almost all cases, death was contributed to by either a delay in referral, or difficulty in accessing blood for transfusion. Relatedly, there was a total of 187 Fresh Still Births, of which a total 75% arrived at the facility with a still fetus. Alternative supply of drugs and medical consumables to public facilities: In line with the project's midterm recommendations JMS was contracted supply quality assured medicines and supply to Public Health facilities. 5 Year 3 of the Project The Uganda Rtproductive Heath Voucher Pojct (UI-JVP) Finanial Statanents fot 12 Months Ended 30 June 201$ 3.1.3 Claims processing re-imbursements and quality assurance During the period, MSU received 314,223 claims amounting to $4,286,663. Of this $3,372,159 (79%) was reimbursed to service providers. The period has been characterized by delayed VSP payments, declining from the expected payment within 20 days in QI to 46 days in Q4. Reimbursement delays were occasioned by the high volume of claims against the low ceiling of the Designated Account (DA) at MOH. The problem was rectified by raising the DA ceiling from US$0.8M to US$2.0 Conclusion; In PY3, the URHVP was implemented at full scale, and remained on track to deliver its objectives. During the next period, the project focus will be on pushing voucher redemption at ANC and delivery from the current 64% to the target 70% and to drive PPFP from 26% to at least 40%. 6 Year 3 of the Project - � к3` � .,, � �'� � л� г� �� � � � ' � :г; :�' � ^n �, � �г� ..и rл -г - г--- r- r. •� +л мs т � _ - _ � � � � � �� � :� � ""• ° ,.. � _ �, ,�, � � � °; - � � � Qё � � � .ц ,�,.. _ - ��-1 �' ., � "� � �у` . � - r--1 ,�„!; .-i 4-� �. � �...,А4 д-� - �� .D9 � � � .,� 'Ч`� вf. уΡО r � � �, , � � � � а У � # S�^г}ь � S" 1 � .. � � - .�-� � �t '� � . !� � вС' t -. �.,, . иw i1г r1г � �� � "YS И � . �1 ' � _ - - ? 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' �ц � � � � � �, ..� � , � г#. � �: � г ,�„ � д* . .. .. � ~ ��. � й � � � � � � � � � .� ° ��"� � �� � � � � '"" С � .� r"'' ��1 � � � � � , �- �� �.� �1 � g. {�ч =у4 - � °® w � � r�, � � � � � � [�+ о � � q '= � s+ � '�, в ra �" 1! � Wo � � а 4. �,} .ьу^ � л r • Ь`1 :г мi �т-� 0 �у .� � � ��������' �� � �� � � ' � � �� � � � �} � � i �, � ����.��� �� �� ���� � ' � а, � � � ~ � W`. � �.. � � ,н' м r1 +п � � .�7 - cs , k"+ лда и1 �� Ри� 'у?wв.� '� - м�и�rи5�лг1 �lur�мp а�вз �иa�uli,i.erJ .маюд sл� ъ-�а��ьхаь ,°ч' Rв�,а� fl� ,�ass� аь�п�мsи� �хаа�ар э;{es�a s�ы��га ra i � i � 3.2 Progress towards Outcome Level 3.2. 1 Number of vouchers sold and redeemed As at end of PY3, URHVP continued to enhance facility-based deliveries through 212 voucher service providers (102 south western and I 10 eastern regions). Out of the 212, 51 VSP sites provide comprehensive emergency obstetric care (CEmOc) and 161 Basic emergency obstetric care (BEmOC) services. During PY3, the project registered 57,832 safe deliveries compared to 55,999 in PY2. By end of PY3, the overall cumulative number of URHVP facility-based deliveries were 115,377, representing a 101.1% achievement of the planned cumulative PY3 projection (114,174). Compared to the overall project life target, the project has registered 74% out of the targeted 156,400 facility-based deliveries for the entire project life as shawn below, By end of PY3, overall redemption of purchased vouchers for delivery was performing at 64% out of the total vouchers (90,299) distributed during the year. This increased from PY2 redemption by a 59/b age points. This has been possible due to the increased routine client follow up by CBDs. 3.2.2 Women attending at least one ANC visit Overall, during PY3 the number of expecting mothers that received at least one antenatal care at VSP supported sites increased substantially to 75,563 (M) from 65,299 (PY2). This translated into a redemption rate of 84% compared to 691% of PY2. Overall there was an increase in ANC redemption rates between PY2 and PY3 by 15% as shown in the graph below. Year 3 of the Project The Uganda Reproductive Health Voucher Project (URHVP) Financial Statements for 12 Months Ended 30 June 2018 ANC trends over the project years 100,000 84% 90% 90,000 69% . 80% 80,000 ** 70% 70,000 60% 60,000 50% 50,000 40% 40,000 30,000 - 0% 20,000 2 20% 10,000 10% 0 - :0% PY1 (Q4) PY2 PY3 l Vouchers Distributed (Cum.) 30,703 94,170 90,299 l Total ( ANCi Attendance 7,086 65,299 75,563 --*% Redemption at ANC1 23% 69% 84% 3.2.3 Mothers attending Post-natal care services (PNC) The provision of postnatal care services has been improving; by the end of PY3, the project registered 39% attendance at postnatal care, this was out of a total of 57,832 deliveries conducted during the PY3. This indicates a 3% growth from PY2 as shown in Graph below. Mothers attending PNC 140,000 45% 3994 120,000 -- 4096 100,000 3096 80,000 2596 60,000 .2096 40,000 15% 20,010 O19 596 PYI (OTR4) PPY Overall achievern m TOtal Deliveries Total PNC -0--% attending PNC 9 Year 3 of the Project The Uganda Reproductive Realth Voucher Project (URVP) FInancial Starcments for 12 Months Ended 30J June2018 3.2.4 Pregnant women tested for HIV During PY3, a total of 75,563 mothers were counselled, tested and received results for HIV. HIV prevalence among this cohort of mothers was recorded at 2.5% (this includes those who attended antenatal care with an already known HIV status) from both regions. Furthermore, 22,420 women were tested during postnatal care. Nearly all, (98%) IIV infected mothers were referred for eMTCT interventions. During the period, there was a change in the HIV testing policy to replace Unigold with Bioline at a tie breaker. This distracted service providers and was coupled with intermittent stock outs. Notably, Bioline is also more expensive than Unigold. 3.2.5 Strengthening referrals for emergency care and linkages between VSPs. During the period, referral linkages between health facilities was strengthened. This was achieved through; Quarterly cluster medical education (CMEs) meetings attended by facility in charges, health workers and a few local leaders. All the URHVP supported VSPs (212) participated in the CMEs during PY3, There was improved feedback loop; and increased access to services by referred clients. Common reasons for emergency referrals include expectant mothers with complications, shortage of blood especially at some Health Centres (HC) IVs among others. During PY3, 7% (n= 4,228) of all mothers that delivered were referred from a BEmOC to a CEmOc facility as compared to 6% (n=3,489) during PY2. 10 Year 3 of the Project The Uganda Reproductive Health Voucher Project (URHVP) Financial Statements for 12 Months Ended 30 June 2018 Mothers referred during the different project years. 12% 140,000 10% 10% 6%-120,000 10%7% 7% 100,000 6% ---- 7% 80,000 6% 60,000 4% 40,000 2% - 20,000 0% -0 PY1 PY2 PY3 Achievement- to-date a No of deliveries 1546 55,999 57,832 115,377 - %--% Pregnant women refereed 10% 6% 7% 7% 3.2.6 Maternal Deaths registered In PY3, URHVP registered 12 maternal deaths. Four (4) of the maternal deaths occurred in the 4th quarter April to June 2018. All 12 of the maternal deaths occurred at CEmOc facilities. Cumulatively URHVP has registered 30 maternal deaths since the inception of the project. On average the project registers three maternal deaths per quarter. Graph showing maternal deaths trends over the years 8 7 7 6 S 4 4 2 1 0 PY1Q4 PY2 Q1 PY2 Q2 PY2Q3 PY2 Q4 PY3 Q2 PY3 Q2 PY3 Q3 PY3 Q4 11 Year 3 of the Project The Uganda Reproductive Health Voucher Project (URHVP) Finncial Satewment for 12 Months Ended XftJunc 2018 3.2.7 Perinatal deaths/Fresh still births In the reporting periods (PY3) there were 187 fresh stillbirths (FSB). Majority of the still births resulted from delays to seek care at facilities. 75% of still births mothers arrived in facility when the foetus was already dead. However, during the project implementation, the ratio of FSB to safe deliveries has remained constant over years Service providers' deficiencies continue to be addressed through cluster (CME) trainings in neonatal resuscitation. During the year, the project acquired 10 Neonates and empowered Quality Assurance Management &, Training Officers to provide mentorship and continuous support supervision in all facilities with capacity gaps in neonatal resuscitation. 3.2.8 Reimbursement of service provider claims During the PY3 VSPs submitted a total of 314,223 claims amounting to USD 4,286,663. Of these, $ 3,372159 was reimbursed to providers. The period was characterized by delayed VSP payments, declining from the expected payment within 20 days in Q I to 46 days in Q4. Reimbursement delays were occasioned by the high volume of claims against Lhe low ceiling of the Designated Account (DA) at MOII. The problem was rectified by raising the DA ceiling from US$0.8M to US$2.0. 12 Year 3 of the Project The Uganda Reproductive Health Voucher.Projecm (URHVP) Financial Stalemeis forl2 Monits Ended 30 June 2018 4.0 FINANCIAL STATEMENTS 4.1 Statement of Income and Expenditure for the Grant UGANDA REPRODUCTIVE HEALTH VOUCHER PROJECT STATEMENT OF INCOME AND EXPENDITURE FOR THE GRANT FOR THE PERIOD OF 12 MONTHS ENDED 30 JUNE 2018 Actual Cumulative income/ Expenditure for Incorne/Expenditure 12 M1onths ended for period ended 30June2ot8 USD;(l) 30 June 2018 USD:(C) RECEIPTS Notes Balance B/F 357,155.52 Dishursement from UHSSP 3(b) 3,5,35,391,168 Direct Payment 3(c) - 1518,048 Total Income for the Year 3,86858*7 6,909,216 Less: EXPENDITURES Voucher Management Agent Cost 4.0 90244.79 1,555,044,79 (Grant) Service Providers Disbursement (Grant] 5.0 2,119,58.02 2,747,673.02 BO East Africa-IVEA (Grant) 6.0 243,996.00 289,838.0O Muinisty of Health (Grant) 7.0 530JAq,92 726o143-39 3,7940tZ& 35,318,699.20 Surplus/(Deficit) including Direct 7 1,590,516.80 Payment to MSU --9 Less. Direct Payment 1.518.048 Surplus/(Deficit) of Income over Expenditure 72,468.79 72,468.80 The notes and Accounting policies set out on 16 to 24 forms an integral part of the Statement of Receipts and Expenditure above for the Uganda Reproductive Health Voucher Project (URHVP) for the period ended 30 June 2018. Ministry of Health approved the Statement on 30/08/2018 and signed on its behalf by: C-EMEIASIONOM/RCCOUT PERMANENT SECRETARYASITNCMISONRCOU5 MINISTRY OF HEALTH MINISTRY OF HEALTH PROJECT CO INATOR MINISTRY OF HEALTH 13 Year 3 of the Project The Uganda Reproductive Health Voueber Project (URHVW) Financial Satements for 12 Months Ended 30 June 2018 4.2 Statement of Fund Balance for the Grant UGANDA REPRODUCTIVE HEALTH VOUCHER PROJECT (URHVP) STATEMENT OF FUND BALANCE FOR THE GRANT FOR THE PERIOD OF 12 MONTHS ENDED 30 JUNE 2018 CASH & BANK DETAILS Currint Year Current Year Balaxce Balance as at as at 30 June 2018 30 June 2017 Notes USD; USD: Cash at Hand & Bank as at 30 June (USD) 2 (a) 50,595.85 352,878.00 Cash at Hand & Bank as at 30 June (UGX) 2 (b) 21,872.94 4277-52 *7,468-79 357,155.52 INCOME & EXPENDITURE Total Cumulative Income 3k868?536.52 1,879,787.00 Less: Cumulative Expenditure 3,79§,967,73 1,522,631.48 7.468.79 357 155.52 PERMNENT SWRETARY ASSISTANT COMMSSIONER/ACCOUNTS MINISTRY OF HEALTH MINISTRY OF HEALTH PROJECT COO.......OR... MINiSTRY OF HEALTH 14 Yoar 3 of the Project The Uganda Reproductive Heakth Voucher Project (URWVF) Financial StAtements for 12 Months Ended 30 Jane 2018 4.3 Statement of Income and Expenditure UHSSP Contribution UGANDA REPRODUCTIVE HEALTH VOUCHER PROJECT (URHVP) STATEMENT OF INCOME AND EXPENDITURE UHSSP CONTRIBUTION FOR THE PERIOD OF 12 MONTHS ENDED 30 JUNE 2018 Actual Cumulative Income/Expenditure Income/Expenditure for 12 Months ezided for period eded 30 June 2018 30 June 2018 UJSD: (8) USD:(C) RECEIPTS Notes Balance B/P Disbursement from UHSSP 3(b) - 3.058,950 Total Income for the Year - 3,0SS,950 Less: EXPENDITURES Voucher Management Agent Cost - 1,424,482 (UHSSP Contribution) Disbursement to Service Providers 9 1,475,864 (UHSSP Contnbuton) Independent Verification & Evaluation Agent (UIISSP 10 158.604 Contribution) Training & Operating Costs 11 - 3,058,950 Surplus/(Deficit) ofIncome over . Expenditure The notes and Accounting policies set out on 16 to 24 forms an integral part of the Statement of Receipts and Expenditure above for the Uganda Reproductive Health Voucher Project (URIVP) UHSSP Contribution for the period ended 30 June 2018. Ministry of Health approved the Statement on 30/08/2018 and signed on its behalf by: ....9.... ..IL Q a .. ...t...... ... L O W 0 4 .... .. PERMANENT SECRETARY ASSISTANT COMIhSSIONER/ACCOUNTS MINISTRY OF HEALTH MINISTRY OF HEALTH PROEtCOfIATOR MINISTRY OF HEALTH 15 Year 3 of the Project The Uganda ReproducUe HeahVocher_rojea (URHVP) Financial Statements for 12 Months EAded 30 June 2018 5.0 Notes to the Financial Statements 1.0 Accounting Entity 1.1 Basis of Preparation The Fund Accountability Statement has been prepared in accordance with the Cash Basis IPSAS Financial Reporting under Cash Basis of Accounting and presents the transactions for the 12 months period ended 30 June 2018. 1.2 Reporting Entity The Fund Accountability Statement is for The Uganda Reproductive Health Voucher Project (URHVP) being implemented under Long Term Institutional Arrangements (LTIA) in the Ministry of Health, 1.4 Reporting Currency and Disbursement of Funds The Reporting currency is US Dollars and the functional currency is UG Shillings. Disbursement methods available to the Project are Advance, Direct Payment and Reimbursement as per the Disbursement Letter. 1.5 Bank Details Project has two currency accounts held in Bank of Uganda, the Designated Account being the United States Dollar and the Uganda Shillings is the Operational Account. The signatories to the accounts include Head Accounts, Project Coordinator and Permanent Secretary of Ministry of Health. Bank Bank of Uganda Account No: 000140088400034 Nature of Account: US Dollars Account No: 000140088000064 Nature of Account: Uganda Shillings 16 Year 3 of the Project The Uganda Reproductive Heath Voucher Project (URHVP) Pinanciat Statements for 12 Months Ended30 June 2018 1.6 Approved Budget/ Work Plan The approved budget was developed on a cash basis of accounting and same classification as the Fund Accountability and all annual budgets are approved by the World Bank 1.7 Cash and cash equivalents Cash and cash equivalents comprise cash at call on account in Bank of Uganda 1.8 Other Funding Source Ministry of Health under the Uganda Health Systems Strengthening Project (UHSSP) ear-Inarked USD: 3,058,950 towards output-based aid. It was agreed that funds due on UHSSP be spent first because the Project was due to close on 30 June 2017. The funds due to Ministry of Health financed by UHSSP have been disbursed and fully utilized under the project. 17 Year 3 of the Project The Uganda Reproductive Health Voucher Project (URHVP) Financia S$tawments for 12 Months Ended 30 June 2018 2 (a) Cash at Hand & Bank Amount in USD Amount in USD as at as at 30 June 2018 30 June 2017 Reconciled Cash Book Balance as at 30 June 50,596 352,878 50,596 352,878 2 (b) Cash at Hand & Bank Amount in UGX Amount in UGX as at as at 30 June 2018 30 June 2017 Reconciled Cash Book Balance as at 30 June 21,872.94 4,277.52 21,872.94 4,277.52 Total Reconciled Cash Book Balance as at 30 June 72,468.79 357,155.52 18 Year 3 of Lhe Project The Uganda Reproductive Health VOucher Projet (URHVP) Financial Scatetmets for 12 Months Ended 30 June 2018 3(a) Remittances from IDA on Grant Actual Income Cumulative Received fox Income 12 Months Received for ended period ended 30 June 2018 30 June 2018 Date USD: USD: 1st Disbursement from IDA 500,000 2nd Disbursement from IDA 29-Aug-16 255,477 450,000 3rd Disbursement from IDA 20-Mar-17 334,582 4th Disbursement from IDA 21-Jun-17 339,728 5th Disbursement from IDA 4-Oct-2017 351,381 351,381 6th Disbursement from IDA 19 Jan-2018 580,000 580,000 7th Disbursement from IDA 9-Mar-2018 740,000 740,000 8th Disbursement from IDA 23-Apr-2018 1,840,000 1,840,000 3,511,381 5,391,168 19 Year 3 of the Project The Uganda Reproductive Helth Voucher Project (URHVP) Financial Saitments for 12 Months Ended 30QJune 2018 3(b) Contribution by UHSSP Actual Income Cumulative Received for Income 12 Months Received for ended period ended 30 June 2018 30 June 2018 Payee Purpose USD: USD: Marie Stopes Uganda(MSU) Reimbursements to 300,000 Service Providers Marie Stopes Uganda(MSU) Voucher Management 726,877 Cost BDO East Africa IVEA Costs 104,992 Marie Stopes Uganda(MSU) Voucher Management 407,390 Cost Marie Stopes Uganda(MSU) Voucher Management 267,543 Cost BDO East Africa IVEA Costs 45,842 BDO East Africa IVEA Costs 7,770 Marie Slopes Uganda(MSU) Reimbursements to 330,000 Service Providers Maric Stopes Uganda(MSU) Reimbursements to 868,536 Service Providers - 3,058,950 20 Year 3 of the Project The Ugatiula Reproductive Heathi Voucher Project (URHVP) Finncial Stmiements for 12 Monhs Ended 30 June Z(ItS 3(c) Direct Payments Actual Income Cumulative Received for Income 12 Months Received for ended period ended 30 June 2018 30 June 2018 Purpose USD: TSD: Direct Payment Reimbursements to Service Providers 1,518,048.00 - 1,518,048.00 Cumulative Voucher Management Current Year Expenditure for 4.0 Agent Cost (Grant) Expenditure the Period ended ended 30 June 2018 30 June 2018 Date USD: (B) USD.. (C) Cumulative Expenditure 4.1 from prior FYS 652,900.00 4.2 Marie Stopes Uganda 22-Jan-2018 m00.0000 200,000.00 4.3 Marie Stopes Uganda 12-Mar-2018 201,100.50 201,100,50 Marie Stopes Uganda 27-Apr-2018 501,0442 9 501,044.29 001,44 79 1,555,044.79 21 Yenr 3 of the Projeci The Upnda Rep roductive Health Voucher Project (URHVP) Financial Stitemean for -2 Months Ended 30 June 2Q18 5.0 Service Providers Disbursement (Grant) Cumulative Current Year Expenditure for Expenditure the Period ended ended 30 June 2018 30 June 2018 Date 08p: (B) USD: IjC) Cumulative Expenditure 5.1 from prior Iy 628,087 Marie Stopes Uganda II Jan 2018 121,056 121,056 5.3 Marie Stopes Uganda 11-Jan-2018 93,481 93,481 5.4 Marie Stopes Uganda 22-Jan-2018 300,000 300,000 5.5 Marie Stopes Uganda 12-Mar-2018 502,751 502,751 5.5 Marie Stopes Uganda 27-Apr-2018 1,102,297 1,102,297 2,119,586.02 2,4673.02 BDO East Africa-IVEA 6.0 (Grant) Cumulative Current Year Expenditure for Ejpenditure the Period ended ended 30 June 20is 30 June 2018 Date US:()USD: (C) Cumulative Expenditure 6. 1 from prior FY 45,842.00 6.2 DtDO East Africa 6-Nov-2017 31,054.00 8D0 East Africa 6.3 6-Nov-2017 44;263,00 44,363.00 6.4 80 East Africa 25-Jan-2018 31,05400 31,054.00 6.5 RDO East Africa 27-Apr-2018 106,471 00 106,471.00 6.6 BDO Fast Africa 20-Jun-2018 31,054.00 31,054.00 243,996.00 289,838.00 22 Year 3 of the Project The Uganda Rtpwductive Health Voucher Projuct (URUVP) Financi] Statements for 12 Months Ended 30 June 2018 Ministry of Health 7.0 (Grant) Cumulative Current Year Expenditure for Expenditure the Period ended ended 30 June 2018 30 June 2018 Date USP: (B) USD: (C) Cumulative Expenditure 7.1 from prior FY 195,802.47 Marie Stopes Uganda 7.2 (MSU) 19-Sep-2017 47,732,93 47,732.93 Marie Stopes Uganda 7.3 (MSUI 18-Oct-2017 111,376.85 111,376.8b PACE 7.4 27-Oct-2017 84,119.74 84,119.74 Uganda Health Marketing 7.5 Group (UHMG) 29-Nov- 2017 67,485.43 67,485.43 PACE 7.6 30-Nov-2017 55,485.48 58,485.48 Marie Stopes Uganda 7.7 (MSIJ) 21-Sep 2017 61,805.36 61,805.36 Project Progress 7.8 Publication in News Papers 99,335,13 99,335.13 MolI oversight Activities 7.9 - 530,340,92 726,143.39 Cumulative Currept Year Expenditure for ExpenditiWe the Period Voucher Management ended ended Agent Cost (UHSSP 30 0bue 2018 30 June 2018 8.0 Contribution) Date ITS (B) USD: (C) 8.1 Cumulative Expenditure from prior FY 1,424,482.00 -_ 1,424,482.00 23 Year 3 of the Project The Uganda Reproductive Health Voucher Project (URHVP) Financial Statements for 12 Months Ended 30 Jufte 2019 Disbursement to Service 9.0 Providers (UHSSP Cumulative Contribution) Current Year Expenditure for Expenditure the Period einded ended 30 June 2018 30 June 2018 Date USD: (B) USD: (C) 9.1 Cumulative Expenditure from prior FY 1,475,864.00 - 1,475,864,00 Independent Verification Cumulative 10 & Evaluation Agent Current Year Expenditure for (UHSSP Contribution) Expenditure the Period ended ended 30 June 2018 30 June 2018 Date USD: (B) USD: (C) 10.1 Cumulative Consultancy 158600 Fees from prior FY - _ 158,604.00 Cumulative Current Year Expenditure for Expaditute the Period aded ended Training & Operating 30 June goS 30 June 2018 11.0 Costs Date USi (B) USD: (C) 24 Year 3 of the Project The Ugunda Reproductive Health Voucher Project (URHVP) Pinancial Sta;emnents for 12Montis Ended 30 June 201R 6.0 Annexes 6.1 Annex 1 UGANDA REPRODUCTIVE HEALTH VOUCHER PROJECT BANK RECONCILIATION STATEMENT FOR THE MONTH ENDED 30 JUNE 2018 ACCOUNT NO: 000140088400034 Amount Amout Details USD: . IISD: Bank Statement Balance As at 30 June 2018 50,S95.85 Less: Un- presented Transactions Add: Direct Credits Cash Book Balance 50,s95 Check!!! (0<00) Prepared y Reviewed by Peter Kajubi Harriet Naluzze Project Accountant AC/Accounts 25 Year 3 of the Project The Uganda& Reproductive Hea1th Voucher Project (URHVP Fimncial Statements for 12 Monhm Ended 30 June 2018 sa S d 4I i i 26 Year 3 of the Project The tUganda Rcpmoductive Icath Voucher Project (L-RHV?) Finacal Statone nts for 12 Months Ended 3 June 2018 6.2 Annex 2 UGANDA REPRODUCTIVE HEALTH VOUCHER PROJECT BANK RECONCILIATION STATEMENT FOR THE MONTH ENDED 30 JUNE 2018 ACCOUNT NO: 000140088000088 S Amount Amount Details UGX: |UD: Bank Stateuient Balance As at 30 June 2018 79,361,792 21872.94 Less: Un-presented Transactions Add: Direct Credits Cash Book Balance 79,361,792 21,872.94 Check!! (0 0) Pre y Reviewed by Peter Kaju i Harriet Naluzze Project A ountant AC/Accounts 27 Year 3 of the Project The Uganda Reproductive Hcakh Voucher Projec (URHVP) Financial Statements for 12 Months Ended 30 June 2018 C>o= 28 Ycar 3 of the Project