Missed Opportunity for Neonates to Live: A Cross-Sectional study on Utilization of Peri-Natal Death Audits to address the Causes of Peri-Natal Mortality in District Hospitals of East–Central Uganda.

Aim:  To assess the utilization of PDAs in addressing the avoidable causes of perinatal mortality in the eastern region of Uganda. Methodology:  A cross-section design using a mixed method was conducted between 2014-2015 at Iganga, Bugiri, and Kamuli general hospitals in the East-Central region of Uganda. The interviews involved 115 health workers who included Doctors, Nurses/Midwives, Clinical officers, and Laboratory and Theatre staff. These were drawn from four departments including the Maternity ward, Outpatient department, Theatre, and pediatric ward. Hospital top and departmental managers formed the key informants for this study. Annual reports for the period 2009/10-2012/13 were reviewed. In addition, monthly reports for the calendar year 2013 together with patients’ clinical case notes and patients’ registers were also reviewed to determine the magnitude and causes of perinatal mortality. Factors contributing to perinatal death were assessed and categorized into fetal, maternal, and health facility factors. Results:  Results revealed a high and rising perinatal mortality rate of 70/1,000 live births and a decreasing maternal mortality ratio of 363/100,000 live births. Most perinatal deaths were fresh stillbirths 48/88 which occurred during the intrapartum period and the majority of early neonatal death was due to birth asphyxia. None of the health facilities was conducting perinatal death audits and the quality of data used for perinatal death audits was inadequate and was scored poorly. Challenges hindering utilization of perinatal death audits included lack of staff sensitization and training, work overload, lack of motivation, fear of blame and litigation, political interference, and lack of support from the community. Conclusion:  There was a high prevalence of perinatal deaths in east-central Uganda yet none of the hospitals was conducting perinatal death reviews. Recommendations: Health workers should be trained on perinatal death audit tools and guidelines. Records departments to revitalize with tools and personnel for effective data management

'I believe that the staff have reduced their closeness to patients': an exploratory study on the impact of HIV/AIDS on staff in four rural hospitals in Uganda

<p>Abstract</p> <p>Background</p> <p>Staff shortages could harm the provision and quality of health care in Uganda, so staff retention and motivation are crucial. Understanding the impact of HIV/AIDS on staff contributes to designing appropriate retention and motivation strategies. This research aimed 'to identify the influence of HIV/AIDS on staff working in general hospitals at district level in rural areas and to explore support required and offered to deal with HIV/AIDS in the workplace'. Its results were to inform strategies to mitigate the impact of HIV/AIDS on hospital staff.</p> <p>Methods</p> <p>A cross-sectional study with qualitative and quantitative components was implemented during two weeks in September 2005. Data were collected in two government and two faith-based private not-for-profit hospitals purposively selected in rural districts in Uganda's Central Region. Researchers interviewed 237 people using a structured questionnaire and held four focus group discussions and 44 in-depth interviews.</p> <p>Results</p> <p>HIV/AIDS places both physical and, to some extent, emotional demands on health workers. Eighty-six per cent of respondents reported an increased workload, with 48 per cent regularly working overtime, while 83 per cent feared infection at work, and 36 per cent reported suffering an injury in the previous year. HIV-positive staff remained in hiding, and most staff did not want to get tested as they feared stigmatization. Organizational responses were implemented haphazardly and were limited to providing protective materials and the HIV/AIDS-related services offered to patients. Although most staff felt motivated to work, not being motivated was associated with a lack of daily supervision, a lack of awareness on the availability of HIV/AIDS counselling, using antiretrovirals and working overtime. The specific hospital context influenced staff perceptions and experiences.</p> <p>Conclusion</p> <p>HIV/AIDS is a crucially important contextual factor, impacting on working conditions in various ways. Therefore, organizational responses should be integrated into responses to other problematic working conditions and adapted to the local context. Opportunities already exist, such as better use of supervision, educational sessions and staff meetings. However, exchanges on interventions to improve staff motivation and address HIV/AIDS in the health sector are urgently required, including information on results and details of the context and implementation process.</p

TOPICAL ISSUE: HUMAN RESOURCES - EXPORT HEALTH WORKERS? FOR UGANDA, AN INDECENT PROPOSAL UNTIL ...

This paper challenges the decision by the Government of Uganda to export health workers to developed countries. It argues that while the Ugandan National Health Policy emphasises strengthening the numbers of health personnel in order to be able to provide a minimum health care package and to redress the imbalances in distribution of skilled staff, it is totally contradictory to start exporting the few personnel available. The paper acknowledges that there are high rates of unemployment in the country and that there are well-recognised benefits of migration of skilled personnel. It also acknowledges that Ugandan health workers have always been on the exodus. However, it also asserts that given the inadequate human resource for health capacity of the country, the government has no justification facilitating the exodus by providing a platform for foreign headhunters of health workers. Finally, it points out some problems that are likely to arise from this untimely export of health workers as well as some measures that the country could adopt to maximize the benefit from Uganda's migrant workers

Factors related to the uptake of natural family planning by clients of catholic health units in Masaka Diocese, Uganda

Globally and locally in Uganda, family planning (FP) is promoted to enable individuals and couples to space and limit childbirth. FP promotion is based on demographic and health concerns and basic human rights. Clients can use either artificial family planning (AFP) or natural family planning (NFP) methods but none is 100% effective. Whereas NFP methods are known to be free from side effects, with no continuous costs, and widely accepted by most religions and cultures, most clients use AFP methods despite their many side effects and costs. The Roman Catholic Church (RCC) opposes AFP methods on fundamental grounds such as the definition of the onset of life and the purpose of sexual union. Additional reasons fronted by the church include the potential misuse of AFP methods and the false sense of security they impart to the users. This study set out to find out how health services under the RCC promote the use of NFP methods in an area of heavy RCC presence, and how these efforts translate into uptake of the methods. It shows that despite the recommendation of NFP methods, RCC health units did not have staff trained in promoting and offering NFP methods. There were no budgets, supplies, registers, teaching AIDS, and no records of NFP clients were kept. No space for NFP clinics was provided and there was no arrangement for continuous professional education (CPE) for NFP providers. Basic knowledge about NFP e.g. the role of breastfeeding and periodic abstinence was acquired from friends. Knowledge about NFP methods was insufficient among clients to the services and in some health workers. Most of the respondents, of which 76 %( 154/202) were Catholics had more information about AFP methods and knew where to access them. The study recommends that RCC authorities in Uganda, as the main champions of NFP, need to provide political commitment to NFP, invest more in and reinvigorate the teaching of NFP methods through their structures. In addition, there is need for support supervision on NFP access and use within RCC health facilities

I found myself staying - A case study of the job embeddedness and retention of qualified health workers in rural and remote areas of Uganda

Global health worker maldistribution affects poor countries and rural areas most adversely, despite their high disease burden. Health workers reject rural areas due to isolation, and lack of facilities. Recommended extrinsic interventions to address rural-urban imbalance are costly and not sustainable in most developing countries. However, some health workers serve in rural areas without such interventions, suggesting existence of strong intrinsic motives for rural practice choice and retention, knowledge of which could be used to select retainable staff. This PhD research, a mixed-methods case study of 50 purposively-selected doctors and nurses retained in 12 Ugandan rural government and private general hospitals for three or more years, sought to find the reasons some qualified health workers get retained in rural areas, and the role of job embeddedness, a construct which predicts employee turnover, in their retention. Rural practice choices were made for personal or altruistic reasons and in obedience to authorities. Rural integration and embeddedness depended upon social and pre-service technical preparation, leading to cultural competence, adaptability, self-efficacy and resilience to shocks. Retention depended on feeling satisfied with achievements or self-adjustment. Despite a modest average degree of rural job embeddedness, rural retention averaged 19 years and most participants did not intend to leave soon. Job embeddedness predicted the duration of retention but not intention to leave. The strongest dimensions of job embeddedness were “fit-organisation” and “fit-community”. Prosocial behaviour and self-efficacy in rural practice influence rural practice choice and retention, and job embeddedness generally increases with retention. The study contributes the job embeddedness construct to the theory of health worker retention research. It also extends the use of the construct to mixed-methods studies, raises rural retention to the policy and research agendas and highlights the role of prosocial behaviour, self-efficacy and good managerial practices in rural practice choice and retention

Do Ugandan medical students intend to work in rural health facilities after training?

There is a persistent shortage of qualified health workers globally, but worse in developing countries, where it is even worse in rural areas than urban and peri-urban areas. Health workers refuse to be deployed in rural areas or migrate to urban areas in search of better physical facilities and to avoid professional isolation, among other reasons. Health workers brought up in urban areas have not experienced rural life and find it difficult to countenance a professional life in rural areas. Several training institutions have engaged in programmes to expose pre-service health workers to rural health work to demystify it and to enable the professionals make an informed choice on practice location after qualification. In this study, the intentions of Ugandan medical students to work in rural health facilities after qualification were sounded out, together with the factors that affect them and their perception of rural areas. The study covered five government medical schools (2 for doctors and 3 for Clinical Officers). Students of all years of study in the different courses were interviewed, as well as key informants in the administration of the schools. At least one half of all the respondents (50% or 167/336) were clear that they did not intend to work in the rural facilities after training, while the other half was divided equally among those who wanted and those who were not sure yet. Whereas the proportion of those intending to work in rural areas rose progressively from the first year of studies, it reached a peak in the pre-final year (fourth year for student doctors and second year for clinical officers) and plummeted in the final year after the students had residential field experience. The majority of the students had a negative perception about working in the rural areas and associated them with lack of physical facilities, social services and communication. Personal demographic characteristics and previous exposure to a rural life did not seem to be related to a choice about work in rural areas. Most of the few students who intended to work in rural areas hoped to stay for not more than three years, before going either for further studies or for self-employment in urban areas. The paper recommends review of the community exposure programmes of the medical schools, with a view to improve support supervision in the field and logistical support for the students during attachment. It also recommends better facilitation of rural health facilities and better incentives and remuneration for rural health workers