Makerere University College of Health Sciences’ role in addressing challenges in health service provision at Mulago National Referral Hospital

<p>Abstract</p> <p>Background</p> <p>Mulago National Referral Hospital (MNRH), Uganda’s primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS) have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH.</p> <p>Methods</p> <p>Key informant interviews (n=23) and focus group discussions (n=7) were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis.</p> <p>Results</p> <p>Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies), staff inadequacies (knowledge, motivation, and professionalism), overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications.</p> <p>Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism, communication skills, strategies that promote evidence-based practice and managerial leadership skills.</p> <p>Conclusions</p> <p>Although there are numerous barriers to delivery of quality health services at MNRH, many barriers could be addressed by strengthening the relationship between the Hospital and MakCHS. Strategic partnerships and creative use of existing resources, both human and financial, could improve the quality of care and service delivery at MNRH. Improving services and providing more skills training could better prepare MakCHS graduates for leadership roles in other health care facilities, ultimately improving health outcomes throughout Uganda.</p

Learning health professionalism at Makerere University: an exploratory study amongst undergraduate students

<p>Abstract</p> <p>Background</p> <p>Anecdotal evidence shows that unprofessional conduct is becoming a common occurrence amongst health workers in Uganda. The development of appropriate professional values, attitudes and behaviors is a continuum that starts when a student joins a health professional training institution and as such health professionals in training need to be exposed to the essence of professionalism. We sought to explore undergraduate health professions students' perceptions and experiences of learning professionalism as a preliminary step in addressing the problem of unprofessional conduct amongst health workers in Uganda.</p> <p>Methods</p> <p>Eight focus group discussions were conducted with 49 first to fifth year health professions undergraduate students of the 2008/2009 academic year at Makerere University College of Health Sciences. The focus group discussions were recorded and transcribed, and were analyzed using content analysis with emergent coding.</p> <p>Results</p> <p>The difference in the way first and fifth year students of Makerere University College of Health Sciences conceptualized professionalism was suggestive of the decline in attitude that occurs during medical education. The formal curriculum was described as being inadequate while the hidden and informal curricula were found to play a critical role in learning professionalism. Students identified role models as being essential to the development of professionalism and emphasized the need for appropriate role modeling. In our setting, resource constraints present an important, additional challenge to learning universal standards of health professionalism. Furthermore, students described practices that reflect the cultural concept of communalism, which conflicts with the universally accepted standard of individual medical confidentiality. The students questioned the universal applicability of internationally accepted standards of professionalism.</p> <p>Conclusions</p> <p>The findings call for a review of the formal professionalism curriculum at Makerere University College of Health Sciences to make it more comprehensive and to meet the needs expressed by the students. Role models need capacity building in professionalism as health professionals and as educators. In our setting, resource constraints present an additional challenge to learning universal standards of health professionalism. There is need for further research and discourse on education in health professionalism in the Sub-Saharan context of resource constraints and cultural challenges.</p

Child and adolescent mental health services in Uganda

Barn og ungdoms psykiske helsetjenester i Uganda Introduksjon Over hele verden lider 1 av 5 barn av psykisk sykdom, mens de står overfor begrensede muligheter for behandling og restitusjon. Mens de vokser opp, står de overfor flere utfordringer som kan bidra til utviklingen av psykiske lidelser. Uganda er et utviklingsland med en historie preget av langvarige borger- og regionale kriger med barnesoldater, stort antall flyktninger og internt fordrevne på grunn av naturkatastrofer og uro, og en stor smittsom sykdomsbyrde hovedsakelig på grunn av akutte luftveisinfeksjoner, malaria og HIV / AIDS. Alle disse faktorene kan påvirke den unge befolkningen i Uganda både fysisk og mentalt. Formål Dette er et litteratursøk av eksisterende studier om psykiske helsetjenester for barn og unge i Uganda. Metodikk En scoping review-tilnærming ble brukt til å velge studier om psykiske helsetjenester (CAMHS) i Uganda. Søk i MEDLINE-, Wiley- og PubMed-databasene ble utført ved bruk av kvalifiseringskriterier. Studiene ble oppsummert i tabeller og deretter syntetisert ved hjelp av rammene for helsesystemer designet av Verdens helseorganisasjon (WHO). Dette ble gjort i henhold til de foretrukne rapporteringselementene for systematisk gjennomgang og M-analyser Extension for Scoping Review (PRISMA-ScR) retningslinjer. Resultater Tolv studier ble identifisert; 5 av studiene brukte kvalitative metoder og fokuserte mest på de nåværende begrensningene og styrkene til CAMHS i Uganda, mens 6 kvantitative studier undersøkte effekten av nye intervensjoner. En studie brukte en blandet metode-tilnærming. Oppsummert skisserte studiene et behov for samarbeid med primærhelsesektoren og tradisjonelle healere for å sikre ytterligere menneskelige ressurser, samt behovet for å fokusere på grupper som foreldreløse, HIV / AIDS-berørte ungdommer, tidligere barnesoldater og flyktninger. De ble presentert i henhold til WHOs Frameworks for monitoring health systems performance. Konklusjon Det er relativt få studier utført på barn og unges mentale helsetjenester i Uganda, og de fleste av dem som eksisterer er en del av større studier som involverer flere land. I denne studien prøvde vi å inkludere de som er satt i Uganda, og bare en ser på flere land. De mentale helsetjenestene for barn og unge i Uganda krever forbedring og må fokusere spesielt på sårbare grupper som foreldreløse, HIV / AIDS-berørte ungdommer og tidligere barnesoldater. Det kan styrkes via samarbeid med andre sektorer, integrering i primærhelsetjenesten, reduksjon av stigma og styrket arbeidsstyrke

Additional file 4 of Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000–2018

Additional file 4: Supplemental results.1. README. 2. Prevalence range across districts. 3. Prevalence range between sexes. 4. Prevalence range between ages. 5. Age-specific district ranges