the poor, improve engagement of the private-for-profit sector, enhance efficiency, strengthen stakeholder coordination, improve service quality, and stimulate consumer-based advocacy for better health. The Ministry of Health (MOH) also conducts annual health sector performance appraisals that assess health system performance and monitor progress in delivery of the UNMHCP. The 2011 USAID report assessing Uganda's health care system pointed to the fact that the UNMHCP often sets health sector targets and activities without an adequate analysis of the costs involved or the implementation of measures to allocate required resources appropriately. A number of factors affect the quality of services in Uganda, including the shortage of healthcare workers and lack of trust in them, a lack of needed treatments, high costs, and long distances to facilities. In 2009, a survey conducted of Ugandan patients indicated a decline in the performance of the public sector health services. These were indicated through comments about poor sanitation, a lack of professionals and drugs and equipment, long wait times, inadequate preventative care, a poor referral system, rude health workers, and lack of services for vulnerable populations like the poor and elderly. The quality of services affects utilization in different ways, including preventing patients from seeking out delivery services or leading them to see traditional providers, self-medicate, and decide not to seek formal care or seeing private providers. Health workforce There is a significant shortage of health workers in Uganda. A Human Resources for Health Policy is in place to guide recruitment, deployment, and retention of health staff. In spite of this, shortages of health workers persist. According to a 2009 published report, there is one doctor for every 7,272 Ugandans. The related statistic is 1:36,810 for nurse/midwifery professionals. The shortages are worse in rural areas where 80 percent of the population resides, as 70 percent of all doctors are practicing in urban areas. There are 61 institutions that train health workers, with five medical colleges, twenty-seven allied health training schools, and twenty nine nursing schools. Community health worker training has increased since the 2000s. The Ugandan Ministry of Health implemented the Village Health Teams (VHT) Training Program to develop community health workers who connect rural communities to health facilities and aid in the spread of preventative knowledge about malaria, pneumonia, worm infestations, diarrhea, and neglected tropical disease.[17] VHTs have also aided in health campaigns and disease surveillance. Nongovernmental organizations, such as Health Child Uganda and Omni