By Francis Edonyu and Benon Tumwine
Health facilities, especially those that provide primary health care services to indigenous populations, operate in resource constrained and hard-to-reach-hard-to-stay settings. This begs the question of how such facilities are expected to meaningfully contribute to the ideals of universal health coverage and deliver quality health benefits and wellbeing to communities, affordably and in responsiveness to their needs.
Such health facilities frequently encounter access barriers and financial risks, hindering their ability to fulfill their mandate effectively. A strategic approach to this challenge involves enhancing the capacity of health facilities to optimize their performance. Simultaneously, it necessitates addressing the underlying factors that influence the demand for health services.
Guidance on risk management in public institutions can be found in The Public Financial Management Act 2015 (as amended), Treasury Instructions 2017 and The National Development Plan III. Privately owned facilities may opt to adopt these or other technical notes.
More specifically, Instruction 6.5.2 (e) of the Instructions to Treasury 2017 recommends that facilities use a simplified risk register to document the risks that may affect performance.
Preparing a register involves identifying the risk and its root causes, clearly describing the risk, and rating the risk. Facilities may thereafter adopt or adapt responses to the critical threats by accepting, reducing, transferring, or avoiding the risk.
When healthcare facilities adopt a risk focus to management, they are better equipped to reduce the variability of outcomes and thus minimise patient harm. By adopting proactive measures and implementing robust protocols, hospitals and clinics can significantly reduce adverse events and ensure patient safety is a key consideration in their decision making processes.
Further, facilities that prepare risk registers are likely to identify potential service fail points and establish safeguards to prevent them from occurring. Therefore, preparing risk registers contributes to reducing the occurrence of medical errors thereby protecting patients and enhancing overall reputation of the facility.
“Risk is any event which is likely to
adversely affect the ability of a vote to
achieve its set objectives.Risk Management involves
implementing an effective programme
that continuously and systematically
identifies, tracks and mitigates risks
that could adversely impact the vote in
achieving its objectives”
Instruction 6.5.1 Treasury
Instructions 2017
To achieve desired outcomes of enhanced financialefficiency and improved health service delivery, while mitigating the impact of demand-side challenges, health facilities—particularly those in resource-constrained settings—should prioritize risk management. This entails identifying and addressing threats to expected outcomes through documentation
and strategic response measures. Depending on the probability and severity of these threats, facilities may choose to accept, avoid, mitigate, or transfer the risk— financial or non-financial. It is important to recognize that the risk landscape within facilities is dynamic and requires ongoing monitoring and adaptation.
Risk management at facility level may lead to financial efficiency through cost savings and compliance. Generally, health facility managers are more accustomed to managing what hasgone wrong (management of problems) than what could go wrong (management of risk).
Therefore, when risks go unmanaged, they often lead to malpractice claims and penalties for noncompliance.
In Uganda, regional referral hospitals are progressively undertaking measures to prepare and regularly update their risk registers and risk mitigation plans as part of the hospital wide work planning and management strategy. The risk mitigation plans include safeguards against potential risks for clinical and public financial management outcomes. Further safeguards are available in professional guidelines such as evidence-based clinical practice guidelines which
aim to standardize case management across health facilities, minimize medical errors and variations in treatment plans.
Therefore, by incorporating risk management as an integral part of management, it may be argued that health facilities are more empowered to deliver affordable and quality care that is more responsive to population needs. In Uganda’s context, risk management potentially transforms regional referral hospitals to centres of excellence for medical care and public health response thereby creating a sustainable platform for transference of technical assistance to lower-level facilities. However, there is still more work that needs to be done to build the capacity of health facilities to prepare risk based work plans.
Francis Edonyu(fedonyu@Kpmg.Com) and Benon Tumwine(btumwine@Kpmg.Com) Advisory Managers with KPMG Uganda. The views and opinions are those of the authors and do not necessarily represent the views and opinions of KPMG.