Key Aspects of Health Policy Development to Improve Surgical Services in Uganda

Recently, surgical services have been gaining greater attention as an integral part of public health in low-income countries due to the significant volume and burden of surgical conditions, growing evidence of the cost-effectiveness of surgical intervention, and global disparities in surgical care. Nonetheless, there has been limited discussion of the key aspects of health policy related to surgical services in low-income countries. Uganda, like other low-income sub-Saharan African countries, bears a heavy burden of surgical conditions with low surgical output in health facilities and significant unmet need for surgical care. To address this lack of adequate surgical services in Uganda, a diverse group of local stakeholders met in Kampala, Uganda, in May 2008 to develop a roadmap of key policy actions that would improve surgical services at the national level. The group identified a list of health policy priorities to improve surgical services in Uganda. The priorities were classified into three areas: (1) human resources, (2) health systems, and (3) research and advocacy. This article is a critical discussion of these health policy priorities with references to recent literature. This was the first such multidisciplinary meeting in Uganda with a focus on surgical services and its output may have relevance to health policy development in other low-income countries planning to improve delivery of surgical services

Essential Surgery at the District Hospital: A Retrospective Descriptive Analysis in Three African Countries

In the first of two papers investigating surgical provision in eight district hospitals in Saharan African countries, Margaret Kruk and colleagues find low levels of surgical care provision suggesting unmet need for surgical services

Intent to migrate among nursing students in Uganda: Measures of the brain drain in the next generation of health professionals

Background: There is significant concern about the worldwide migration of nursing professionals from low-income countries to rich ones, as nurses are lured to fill the large number of vacancies in upper-income countries. This study explores the views of nursing students in Uganda to assess their views on practice options and their intentions to migrate. Methods: Anonymous questionnaires were distributed to nursing students at the Makerere Nursing School and Aga Khan University Nursing School in Kampala, Uganda, during July 2006, using convenience sampling methods, with 139 participants. Two focus groups were also conducted at one university. Results: Most (70%) of the participants would like to work outside Uganda, and said it was likely that within five years they would be working in the U.S. (59%) or the U.K. (49%). About a fourth (27%) said they could be working in another African country. Only eight percent of all students reported an unlikelihood to migrate within five years of training completion. Survey respondents were more dissatisfied with financial remuneration than with any other factor pushing them towards emigration. Those wanting to work in the settings of urban, private, or U.K./U.S. practices were less likely to express a sense of professional obligation and/or loyalty to country. Those who have lived in rural areas were less likely to report wanting to emigrate. Students with a desire to work in urban areas or private practice were more likely to report an intent to emigrate for financial reasons or in pursuit of country stability, while students wanting to work in rural areas or public practice were less likely to want to emigrate overall. Conclusion: Improving remuneration for nurses is the top priority policy change sought by nursing students in our study. Nursing schools may want to recruit students desiring work in rural areas or public practice to lead to a more stable workforce in Uganda.University of Washington Department of Global Healt

Human Resource and Funding Constraints for Essential Surgery in District Hospitals in Africa: A Retrospective Cross-Sectional Survey

In the second of two papers investigating surgical provision in eight district hospitals in Saharan African countries, Margaret Kruk and colleagues describe the range of providers of surgical care and anesthesia and estimate the related costs

Increasing Access to Surgical Services in Sub-Saharan Africa: Priorities for National and International Agencies Recommended by the Bellagio Essential Surgery Group

In this Policy Forum, the Bellagio Essential Surgery Group, which was formed to advocate for increased access to surgery in Africa, recommends four priority areas for national and international agencies to target in order to address the surgical burden of disease in sub-Saharan Africa

Moyer's method of mixed dentition analysis: a meta-analysis

Background: Mixed dentition analysis forms an essential part of an orthodontic assessment. Moyer's method which is commonly used for this analysis is based on data derived from a Caucasian population. The applicability of tables derived from the data Moyer used to other ethnic groups has been doubted. However no meta-analyses have been done to statistically prove this. Objective: To assess the applicability of Moyer's method in different ethnic groups. Study design: A meta-analysis of studies done on other populations using Moyer's method. Method: The seven articles included in this study were identified by a literature search of Medline (1966-June 2003) using predetermined key words, inclusion and exclusion criteria. 195 articles were reviewed and meta-analyzed. Results: Overall the correlation coefficients were found to be borderline in variation with a p-value of 0.05. Separation of the articles into Caucasian and Asian groups also gave borderline p-values of 0.05. Conclusion Variation in the correlation coefficients of different populations using Moyer's method may fall either side. This implies that Moyer's method of prediction may have population variations. For one to be sure of the accuracy while using Moyer's method it may be safer to develop prediction tables for specific populations. Thus Moyer's method cannot universally be applied without question. Key Words: meta-analysis, mixed dentition analysis, Moyer's method African Health Sciences Vol.4(1) 2004: 63-6

Understanding the challenges of improving sanitation and hygiene outcomes in a community based intervention : a cross-sectional study in rural Tanzania

Good sanitation and clean water are basic human rights yet they remain elusive to many rural communities in Sub-Saharan Africa (SSA). We carried out a cross sectional study to examine the impact of a four-year intervention aimed at improving access to water and sanitation and reducing waterborne disease, especially diarrhea in children under five years old. The study was carried out in April and May 2015 in Busangi, Chela and Ntobo wards of Kahama District of Tanzania. The interventions included education campaigns and improved water supply, and sanitation. The percentage of households (HHs) with access to water within 30 min increased from 19.2 to 48.9 and 17.6 to 27.3 in the wet and dry seasons, respectively. The percentage of HHs with hand washing facilities at the latrine increased from 0% to 13.2%. However, the incidence of diarrhea among children under five years increased over the intervention period, RR 2.91 95% CI 2.71–3.11, p < 0.0001. Availability of water alone may not influence the incidence of waterborne diseases. Factors such as water storage and usage, safe excreta disposal and other hygiene practices are critical for interventions negating the spread of water borne diseases. A model that articulates the extent to which these factors are helpful for such interventions should be explored

Use of surgical task shifting to scale up essential surgical services: a feasibility analysis at facility level in Uganda

Background: The shortage and mal-distribution of surgical specialists in sub-Saharan African countries is born out of shortage of individuals choosing a surgical career, limited training capacity, inadequate remuneration, and reluctance on the part of professionals to work in rural and remote areas, among other reasons. This study set out to assess the views of clinicians and managers on the use of task shifting as an effective way of alleviating shortages of skilled personnel at a facility level. Methods: 37 in-depth interviews with key informants and 24 focus group discussions were held to collect qualitative data, with a total of 80 healthcare managers and frontline health workers at 24 sites in 15 districts. Quantitative and descriptive facility data were also collected, including operating room log sheets to identify the most commonly conducted operations. Results: Most health facility managers and health workers supported surgical task shifting and some health workers practiced it. The practice is primarily driven by a shortage of human resources for health. Personnel expressed reluctance to engage in surgical task shifting in the absence of a regulatory mechanism or guiding policy. Those in favor of surgical task shifting regarded it as a potential solution to the lack of skilled personnel. Those who opposed it saw it as an approach that could reduce the quality of care and weaken the health system in the long term by opening it to unregulated practice and abuse of privilege. There were enough patient numbers and basic infrastructure to support training across all facilities for surgical task shifting. Conclusion: Whereas surgical task shifting was viewed as a short-term measure alongside efforts to train and retain adequate numbers of surgical specialists, efforts to upscale its use were widely encouraged.Other UBCNon UBCReviewedFacult