Integrating service delivery in IDP camps: the case of northern Uganda

The mid-north and parts of eastern Uganda are under siege from the LRA and poor health. There are about 1.6 million people displaced by the LRA living in squalid camps. In these camps, the IDPs are cramped in huts built barely a metre away from each other and are solely dependant on food handouts. The staggering burden of disease and poor indicators in the country is contributed to greatly by these conflict areas especially the northern. The severe poverty being experienced in these regions worsens this. General population accessibility to health facilities is not good, being hampered by the general insecurity in the area. Further, because of the rather difficult working environment in the affected districts, the general staffing levels and distribution are poor and insecurity has made the exercise of distributing drugs to lower level units difficult. in order to better the delivery of health services amongst the IDPs, four areas have to be addressed; these are increasing services to the IDPs and encouraging the utilisation of these services; deploying appropriate health workers; education and reiterating the SWAp working arrangement. However the missing link between these interventions and achieving good performance and health indicators in the IDP camps has been verticalism and an uncoordinated delivery of health services by the various stakeholders and partners working amongst the IDPs. This paper advocates for an integrated delivery of health services amongst IDPs in order to achieve the best possible outcomes from priority interventions

The effort to achieve the Millennium Development Goals in Uganda: reaching for the sky?

At the United Nations Millennium Summit in September 2000, world leaders placed development at the heart of the global agenda by adopting the Millennium Development Goals (MDGs). The Government of Uganda is a signatory to this and the Poverty Eradication Action Plan (PEAP), which is also the Country's Poverty Reduction Strategy Paper (PRSP), is Uganda's national development framework and medium term planning tool to achieve the MDGs. In the health sector, targets are not yet being met

Primary health care and health sector reforms in Uganda

The health system in Uganda has undergone a number of changes since independence in 1962 and the PHC concept was a timely innovation, and very welcome in Uganda. And also as a response to the global economic decline of the 1970s and 1980s, the World Bank and IMF introduced Structural Adjustment Programmes (SAPs) in some developing countries and accordingly a package of reforms was proposed to address problems in the health sector, and these were called health sector reforms (HSR). Both PHC and HSR have faced similar and dissimilar challenges

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

INTEGRATING SERVICE DELIVERY IN IDP CAMPS: THE CASE OF NORTHERN UGANDA

The mid-north and parts of eastern Uganda are under siege from the LRA and poor health. There are about 1.6 million people displaced by the LRA living in squalid camps. In these camps, the IDPs are cramped in huts built barely a metre away from each other and are solely dependant on food handouts. The staggering burden of disease and poor indicators in the country is contributed to greatly by these conflict areas especially the northern. The severe poverty being experienced in these regions worsens this. General population accessibility to health facilities is not good, being hampered by the general insecurity in the area. Further, because of the rather difficult working environment in the affected districts, the general staffing levels and distribution are poor and insecurity has made the exercise of distributing drugs to lower level units difficult. in order to better the delivery of health services amongst the IDPs, four areas have to be addressed; these are increasing services to the IDPs and encouraging the utilisation of these services; deploying appropriate health workers; education and reiterating the SWAp working arrangement. However the missing link between these interventions and achieving good performance and health indicators in the IDP camps has been verticalism and an uncoordinated delivery of health services by the various stakeholders and partners working amongst the IDPs. This paper advocates for an integrated delivery of health services amongst IDPs in order to achieve the best possible outcomes from priority interventions

Primary health care and health sector reforms in Uganda

The health system in Uganda has undergone a number of changes since independence in 1962 and the PHC concept was a timely innovation, and very welcome in Uganda. And also as a response to the global economic decline of the 1970s and 1980s, the World Bank and IMF introduced Structural Adjustment Programmes (SAPs) in some developing countries and accordingly a package of reforms was proposed to address problems in the health sector, and these were called health sector reforms (HSR). Both PHC and HSR have faced similar and dissimilar challenges

The effort to achieve the Millenium development goals in Uganda: reaching for the sky?

At the United Nations Millennium Summit in September 2000, world leaders placed development at the heart of the global agenda by adopting the Millennium Development Goals (MDGs). The Government of Uganda is a signatory to this and the Poverty Eradication Action Plan (PEAP), which is also the Country's Poverty Reduction Strategy Paper (PRSP), is Uganda's national development framework and medium term planning tool to achieve the MDGs. In the health sector, targets are not yet being met

THEME ONE: Coping with armed conflict PLANNING HEALTH CARE FOR INTERNALLY DISPLACED PERSONS: EXPERIENCES IN UGANDA

A significant proportion of Ugandans have at one time or another been forced to flee their homes. In 1997 alone, point prevalence revealed that 2,000,000 persons were displaced and it is estimated that currently about 1.6 million Ugandan are internally displaced. The ten districts in the north and northeastern Uganda have the biggest problems of displacement with Gulu district having the highest number of IDPs. The status of IDPs is unpredictable. The objective of health care services for IDPs is to reduce excess mortality (currently twice that of districts without IDPs) and morbidity among the Internally Displaced Persons through interventions that target the most vulnerable (women, children, disabled) in these communities. The natural response in Uganda for the affected districts in the North and North- Eastern parts of the country has been multisectoral. This paper proposes how priority health interventions can be designed and delivered in IDP camps, above all stressing the role of coordination

Theme one: Coping with armed conflict \u2013 Planning health care for internally displaced persons: Experiences in Uganda

A significant proportion of Ugandans have at one time or another been forced to flee their homes. In 1997 alone, point prevalence revealed that 2,000,000 persons were displaced and it is estimated that currently about 1.6 million Ugandan are internally displaced. The ten districts in the north and northeastern Uganda have the biggest problems of displacement with Gulu district having the highest number of IDPs. The status of IDPs is unpredictable. The objective of health care services for IDPs is to reduce excess mortality (currently twice that of districts without IDPs) and morbidity among the Internally Displaced Persons through interventions that target the most vulnerable (women, children, disabled) in these communities. The natural response in Uganda for the affected districts in the North and North- Eastern parts of the country has been multisectoral. This paper proposes how priority health interventions can be designed and delivered in IDP camps, above all stressing the role of coordination