Cost of malaria morbidity in Uganda

Background: The high burden of malaria, among others, is a key challenge to both human and economic development in malaria endemic countries. The impact of malaria can be categorized from three dimensions, namely: health, social and economic. The economic dimension focuses on three types of effects, namely: direct, indirect and intangible effects which are felt at both macro and micro levels. The objective of this study was to estimate the costs of malaria morbidity in Uganda using the cost-of-illness approach. Methods: The study covered 4 districts, which were selected randomly after stratification by malaria endemicity into Hyper endemic (Kamuli and Mubende districts); Meso endemic (Mubende) and Hypo endemic (Kabale). A survey was undertaken to collect data on cost of illness at the household level while data on institutional costs was collected from the Ministry of Health and Development Partners. Results: Our study revealed that: (i) in 2003, the Ugandan economy lost a total of about US$658,200,599 (US$24.8 per capita) due to 12,343,411 cases malaria; (ii) the total consisted of US$49,122,349 (7$ 609,078,209 (92%) indirect costs or productivity losses; (iv) the total malaria treatment-related spending was US$46,134,999; out of which 90$2,987,351 was spent on malaria prevention; out of which 81% was borne by MOH and development partners. Conclusion: Malaria poses a heavy economic burden on households, which may expose them to financial catastrophe and impoverishment. This calls for the upholding of the no-user fees policy as well as increased investments in improving access to quality of health services and to proven community preventive interventions in order to further reduce the cost of illness borne by patients and their families

Cost of malaria morbidity in Uganda

The high burden of malaria, among others, is a key challenge to both human and economic development in malaria endemic countries. The impact of malaria can be categorized from three dimensions, namely: health, social and economic. The economic dimension focuses on three types of effects, namely: direct, indirect and intangible effects which are felt at both macro and micro levels. The objective of this study was to estimate the costs of malaria morbidity in Uganda using the cost-of-illness approach. The study covered 4 districts, which were selected randomly after stratification by malaria endemicity into Hyper endemic (Kamuli and Mubende districts); Meso endemic (Mubende) and Hypo endemic (Kabale). A survey was undertaken to collect data on cost of illness at the household level while data on institutional costs was collected from the Ministry of Health and Development Partners. Our study revealed that: (i) in 2003, the Ugandan economy lost a total of about US$658,200,599 (US$24.8 per capita) due to 12,343,411 cases malaria; (ii) the total consisted of US$49,122,349 (7$ 609,078,209 (92%) indirect costs or productivity losses; (iv) the total malaria treatment-related spending was US$46,134,999; out of which 90$2,987,351 was spent on malaria prevention; out of which 81% was borne by MOH and development partners.  Malaria poses a heavy economic burden on households, which may expose them to financial catastrophe and impoverishment. This calls for the upholding of the no-user fees policy as well as increased investments in improving access to quality of health services and to proven community preventive interventions in order to further reduce the cost of illness borne by patients and their families. Key words: Cost of illness, malaria, Ugand

Do guidelines influence the implementation of health programs? — Uganda’s experience

Abstract Background A guideline contains processes and procedures intended to guide health service delivery. However, the presence of guidelines may not guarantee their implementation, which may be a result of weaknesses in the development process. This study was undertaken to describe the processes of developing health planning, services management, and clinical guidelines within the health sector in Uganda, with the goal of understanding how these processes facilitate or abate the utility of guidelines. Methods Qualitative and quantitative research methods were used to collect and analyze data. Data collection was undertaken at the levels of the central Ministry of Health, the district, and service delivery. Qualitative methods included review of documents, observations, and key informant interviews, as well as quantitative aspects included counting guidelines. Quantitative data were analyzed with Microsoft Excel, and qualitative data were analyzed using deductive content thematic analysis. Results There were 137 guidelines in the health sector, with programs related to Millennium Development Goals having the highest number (n = 83). The impetus for guideline development was stated in 78% of cases. Several guidelines duplicated content, and some conflicted with each other. The level of consultation varied, and some guidelines did not consider government-wide policies and circumstances at the service delivery level. Booklets were the main format of presentation, which was not tailored to the service delivery level. There was no framework for systematic dissemination, and target users were defined broadly in most cases. Over 60% of guidelines available at the central level were not available at the service delivery level, but there were good examples in isolated cases. There was no framework for systematic monitoring of use, evaluation, and review of guidelines. Suboptimal performance of the supervision framework that would encourage the use of guidelines, assess their utilization, and provide feedback was noted. Conclusions Guideline effectiveness is compromised by the development process. To ensure the production of high-quality guidelines, efforts must be employed at the country and regional levels. The regional level can facilitate pooling resources and expertise in knowledge generation, methodology development, guideline repositories, and capacity building. Countries should establish and enforce systems and guidance on guideline development.</p

A critique of the Uganda district league table using a normative health system performance assessment framework

Background: In 2003 the Uganda Ministry of Health (MoH) introduced the District League Table (DLT) to track district performance. This review of the DLT is intended to add to the evidence base on Health Systems Performance Assessment (HSPA) globally, with emphasis on Low and Middle Income Countries (LMICs), and provide recommendations for adjustments to the current Ugandan reality. Methods: A normative HSPA framework was used to inform the development of a Key Informant Interview (KII) tool. Thirty Key Informants were interviewed, purposively selected from the Ugandan health system on the basis of having developed or used the DLT. KII data and information from published and grey literature on the Uganda health system was analyzed using deductive analysis. Results: Stakeholder involvement in the development of the DLT was limited, including MoH officials and development partners, and a few district technical managers. Uganda policy documents articulate a conceptually broad health system whereas the DLT focuses on a healthcare system. The complexity and dynamism of the Uganda health system was insufficiently acknowledged by the HSPA framework. Though DLT objectives and indicators were articulated, there was no conceptual reference model and lack of clarity on the constitutive dimensions. The DLT mechanisms for change were not explicit. The DLT compared markedly different districts and did not identify factors behind observed performance. Uganda lacks a designated institutional unit for the analysis and presentation of HSPA data, and there are challenges in data quality and range. Conclusions: The critique of the DLT using a normative model supported the development of recommendation for Uganda district HSPA and provides lessons for other LMICs. A similar approach can be used by researchers and policy makers elsewhere for the review and development of other frameworks. Adjustments in Uganda district HSPA should consider: wider stakeholder involvement with more district managers including political, administrative and technical; better anchoring within the national health system framework; integration of the notion of complexity in the design of the framework; and emphasis on facilitating district decision-making and learning. There is need to improve data quality and range and additional approaches for data analysis and presentatio

Additional file 1: of National health research systems in the WHO African Region: current status and the way forward

Governance structures for health research in the WHO African Region. (DOCX 21 kb

Conclusions of the digital health hub of the Transform Africa Summit (2018): strong government leadership and public-private-partnerships are key prerequisites for sustainable scale up of digital health in Africa

Abstract Background The use of digital technologies to improve access to health is gaining momentum in Africa. This is more pertinent with the increasing penetration of mobile phone technology and internet use, and calls for innovative strategies to support implementation of the health-related Sustainable Development Goals and Universal Health Coverage on the continent. However, the huge potential benefits of digital health to advance health services delivery in Africa is yet to be fully harnessed due to critical challenges such as proliferation of pilot projects, poor coordination, inadequate preparedness of the African health workforce for digital health, lack of interoperability and inadequate sustainable financing, among others. To discuss these challenges and propose the way forward for rapid, cost-effective and sustainable deployment of digital health in Africa, a Digital Health Hub was held in Kigali from 8th to 9th May 2018 under the umbrella of the Transform Africa Summit 2018. Methods The hub was organized around five thematic areas which explored the status, leadership, innovations, sustainable financing of digital health and its deployment for prevention and control of Non-Communicable Diseases in Africa. It was attended by over 200 participants from Ministries of Health and Information and Communication Technology, Private Sector, Operators, International Organizations, Civil Society and Academia. Conclusions The hub concluded that while digital health offers major opportunities for strengthening health systems towards the attainment of the Sustainable Development Goals including Universal Health Coverage in Africa, there is need to move from Donor-driven pilot projects to more sustainable and longer term nationally owned programmes to reap its benefits. This would require the use of people-centred approaches which are demand, rather than supply-driven in order to avoid fragmentation and wastage of health resources. Government leadership is also critical in ensuring the availability of an enabling environment including national digital health strategies, regulatory, coordination, sustainable financing mechanisms and building of the necessary partnerships for digital health. Recommendations We call on the Smart Africa Secretariat, African Ministries in charge of health, information and communication technology and relevant stakeholders to ensure that the key recommendations of the hub are implemented