352 research outputs found
Assessing access barriers to maternal health care: measuring bypassing to identify health centre needs in rural Uganda.
BACKGROUND: In low income countries, several barriers exist to the use of health services for child delivery, including distance, transportation, informal costs or low perceived quality. Yet there is rarely information about which barriers are more or less important to the use of a given health facility. This study assessed the relative importance of different barriers to maternal health facility use in rural Uganda through the use of simple indicators based on locally available data. METHODS: Data from public health facilities performing deliveries in a rural district were used along with census information to construct a set of indicators useful for diagnosing barriers to delivery service use. Indicators included the number of facility-based deliveries per 1000 women served, the proportion of users from a facility's local area, and a new indicator, the 'bypassing ratio', defined as the number of women from a facility's local area who delivered in other facilities, divided by the number of local women using the facility itself. RESULTS: Numbers of deliveries varied greatly between facilities of the same level. A few very low use facilities saw over 75% of women come from the local area, while other facilities services attracted a large majority of women from other areas. The phenomenon of bypassing provides additional insight into the relative importance of distance or transport as opposed to internal facility factors preventing use. CONCLUSIONS: Simple and easily replicable tools are essential to assist health managers to identify communities and facilities needing improvements in access to delivery care. The methods developed in this paper could be utilized by local officials in other areas to assist planning and improvement of both maternal care and other health services
Overcoming access barriers for facility-based delivery in low-income settings: insights from Bangladesh and Uganda.
Women in both Bangladesh and Uganda face a number of barriers to delivery in professional health facilities, including costs, transportation problems, and sociocultural norms to deliver at home. Some women in both the countries manage to overcome these barriers. This paper reports on a comparative qualitative study investigating how some women and their families were able to use professional delivery services. The study provides insights into the decision-making processes and overcoming access barriers. Husbands were found to be particularly important in Uganda, while, in Bangladesh, a number of individuals could influence care-seeking, including unqualified local healers or traditional birth attendants. In both the settings, cost and transport barriers were often overcome through social networks. Social prohibitions on birth in the health facility did not feature strongly in women's accounts, with several Ugandan women explaining that friends or peers also used facilities, while, in Bangladesh, perceived complications apparently justified the use of professional medical care. Investigating the ways in which some women can overcome common barriers can help inform policy and planning to increase the use of health facilities for child delivery
Aid alignment: a longer term lens on trends in development assistance for health in Uganda
Background
Over the past decade, development assistance for health (DAH) in Uganda has increased dramatically, surpassing the governmentâs own expenditures on health. Yet primary health care and other priorities identified in Ugandaâs health sector strategic plan remain underfunded.
Methods
Using data available from the Creditor Reporting System (CRS), National Health Accounts (NHA), and government financial reports, we examined trends in how donors channel DAH and the extent to which DAH is aligned with sector priorities. The study follows the flow of DAH from the donor to the implementing organization, specifying the modality used for disbursing funds and categorizing funds based on program area or support function.
Findings
Despite efforts to improve alignment through the formation of a sector-wide approach (SWAp) for health in 1999 and the creation of a fund to pool resources for identified priorities, increasingly DAH is provided as short-term, project-based support for disease-specific initiatives, in particular HIV/AIDS.
Conclusion
These findings highlight the need to better align external resources with country priorities and refocus attention on longer-term sector-wide objectives.UKai
Can donor aid for health be effective in a poor country? Assessment of prerequisites for aid effectiveness in Uganda
Background: Inadequate funding for health is a challenge to attaining health-related Millennium Development Goals. Significant increase in health funding was recommended by the Commission for Macroeconomics and Health. Indeed Official Development Assistance has increased significantly in Uganda. However, the effectiveness of donor aid has come under greater scrutiny. This paper scrutinizes the prerequisites for aid effectiveness. The objective of the study was to assess the prerequisites for effectiveness of donor aid, specifically, its proportion to overall health funding, predictability, comprehensiveness, alignment to country priorities, and channeling mechanisms. Methods:Secondary data obtained from various official reports and surveys were analyzed against the variables mentioned under objectives. This was augmented by observations and participation in discussions with all stakeholders to discuss sector performance including health financing. Results:Between 2004â2007, the level of aid increased from US11. Aid was found to be unpredictable with expenditure varying between 174â360 percent from budgets. More than 50% of aid was found to be off budget and unavailable for comprehensive planning. There was disproportionate funding for some items such as drugs. Key health system elements such as human resources and infrastructure have not been given due attention in investment. The governmentâs health funding from domestic sources grew only modestly which did not guarantee fiscal sustainability. Conclusion: Although donor aid is significant there is need to invest in the prerequisites that would guarantee its effective use
Uganda's minimum health care package: rationing within the minimum?
Essential/minimum health care packages (MHCP) have appeared on the
primary health care scene as a means of setting priorities for national
health budgets. A technical approach of cost-effectiveness was sought
to guide the political and group bargaining approaches. In Uganda, the
application of the cost-effectiveness techniques seem not to have had
an effect on the priority setting. A package of minimum services that
is written into the sector plan has turnout to be more then the
resources available in the medium term. At the operational level, the
delivery of the minimum package has been rendered ineffective and
inefficient, by trying to attain universal access with 28. System capacity constraints for effective and equitable
delivery of the MCHP are traced at the infrastructure-based planning
and in explicit and implicit re-prioritization and rationing within the
minimum package
âThey say we are money mindedâ exploring experiences of formal private for-profit health providers towards contribution to pro-poor access in post conflict Northern Uganda
From Crossref journal articles via Jisc Publications RouterSuzanne Fustukian - ORCID: 0000-0002-4570-5800
https://orcid.org/0000-0002-4570-5800Background: The perception within literature and populace is that the private for-profit
sector is for the rich only, and this characteristic results in behaviours that hinder advancement of Universal health coverage (UHC) goals. The context of Northern Uganda presents an
opportunity for understanding how the private sector continues to thrive in settings with
high poverty levels and history of conflict.Objective: The study aimed at understanding access mechanisms employed by the formal
private for-profit providers (FPFPs) to enable pro-poor access to health services in post
conflict Northern Uganda.Methods: Data collection was conducted in Gulu municipality in 2015 using Organisational
survey of 45 registered formal private for-profit providers (FPFPs),10 life histories, and 13 key
informant interviews. Descriptive statistics were generated for the quantitative findings
whereas qualitative findings were analysed thematically.Results: FPFPs pragmatically employed various access mechanisms and these included fee
exemptions and provision of free services, fee reductions, use of loan books, breaking down
doses and partial payments. Most mechanisms were preceded by managersâ subjective
identification of the poor, while operationalisation heavily depended on the managersâ
availability and trust between the provider and the customer. For a few FPFPs, partnerships
with Non-governmental organisations (NGOs) and government enabled provision of free,
albeit mainly preventive services, including immunisation, consultations, screening for blood
pressure and family planning. Challenges such as quality issues, information asymmetry and
standardisation of charges arose during implementation of the mechanisms.Conclusion: The identification of the poor by the FPFPs was subjective and unsystematic.
FPFPs implemented various innovations to ensure pro-poor access to health services.
However, they face a continuous dilemma of balancing the profit maximization and altruism
objectives. Implementation of some pro-poor mechanisms raises concerns included those
related to quality and standardisation of pricing.The publication of this work has also been funded as part of a supplement under SPEED project [HUM/2014/341-585], funding code is ZGHA-2020-C4168..pubpu
Cost of care for preterm babies to Clients and influence of costs on care in resource limited settings - Societal perspective: A case of Jinja Regional Referral Hospital in East central Uganda
Introduction: The costs of care for preterm birth to clients and the influence of costs on preterm care remain a significant issue to the health system and families globally especially in the low-middle income countries particularly, in Asia and sub-Saharan Africa with already constrained economies. However, this has not received worthwhile attention. We estimated the costs of care for preterm babies to families (clients) and the influence of costs on the care for preterm babies from a societal perspective in Jinja Regional Referral Hospital. Methods: This was a one-month survey from August 2016 â September 2016 through which we had exit interviews with 100 mothers to determine the costs on admission and followed up 82 mothers to determine follow up costs of all babies that were born preterm and weighed less than 2.5 kg either at discharge or follow up. A micro costing approach was used to compute client costs for preterm care. Mothers were asked to identify absolute costs incurred. We also reviewed medical records of patients and receipts that were available from clients. A likert scale was used to assess influence of costs on preterm care to mothers. This ranged from -5 to 5, where (+5 to +1) was high influence, (0) was neutral, (-5 to -1) was low influence. Respondents were also asked to give reasons for their answers. From the provider perspective, we conducted key informant interviews with health care workers to ascertain the influence of costs on preterm care from the provider perspective. Analysis of findings was done using the Microsoft excel sheet. Statistical analysis was done using Stata Version 13 to determine the influence of costs on the care of preterm babies from the client's perspective. Thematic analysis was used to analyze the influence of costs on care from the provider perspective. Costs were converted to US 10,520.36 and the unit cost of care per preterm baby was US$ 105.2 at Jinja Regional Referral Hospital. Cost drivers included opportunity costs (i.e., potential benefits foregone by clients to take care of preterm babies), drug costs on follow up, supplies and feeding costs to the mothers/caregivers during admission. Drugs, supplies thermal care and feeding costs during admission were found to have a high influence on preterm care from a societal perspective. Conclusion: The cost of preterm care is high from the client perspective and is characterized by longer stay in hospital because of missed treatment due to stock outs and affordability constraints to clients, but also discharge against medical advice leading to poor survival of preterm babies. Improving funding for preterm care and welfare for caregivers during hospitalization may lead to better outcomes for preterm babies
Health worker experiences of and movement between public and private not-for-profit sectors-findings from post-conflict Northern Uganda
Background
Northern Uganda suffered 20 years of conflict which devastated lives and the health system. Since 2006, there has been investment in reconstruction, which includes efforts to rebuild the health workforce. This article has two objectives: first, to understand health workers' experiences of working in public and private not-for-profit (PNFP) sectors during and after the conflict in Northern Uganda, and second, to understand the factors that influenced health workers' movement between public and PNFP sectors during and after the conflict.
Methods
A life history approach was used with 26 health staff purposively selected from public and PNFP facilities in four districts of Northern Uganda. Staff with at least 10 years' experience were selected, which resulted in a sample which was largely female and mid-level. Two thirds were currently employed in the public sector and just over a third in the PNFP sector. A thematic data analysis was guided by the framework analysis approach, analysis framework stages and ATLAS.ti software version 7.0.
Results
Analysis reveals that most of the current staff were trained in the PNFP sector, which appears to offer higher quality training experiences. During the conflict period, the PNFP sector also functioned more effectively and was relatively better able to support its staff. However, since the end of the conflict, the public sector has been reconstructed and is now viewed as offering a better overall package for staff. Most reported movement has been in that direction, and many in the PNFP sector state intention to move to the public sector. While there is sectoral loyalty on both sides and some bonds created through training, the PNFP sector needs to become more competitive to retain staff so as to continue delivering services to deprived communities in Northern Uganda.
Conclusions
There has been limited previous longitudinal analysis of how health staff perceive different sectors and why they move between them, particularly in conflict-affected contexts. This article adds to our understanding, particularly for mid-level cadres, and highlights the need to ensure balanced health labour market incentives which take into account not only the changing context but also needs at different points in individuals' life cycles and across all core service delivery sectors.sch_iih14pub4347pub
Health seeking behavior among individuals presenting with chronic cough at referral hospitals in Uganda; missed opportunity for early tuberculosis diagnosis
Funding: This study was conducted with funding from the World Bank under the East African Public Health Laboratory Networking Project (EAPHLNP).Background: Tuberculosis (TB) is the 9th leading cause of death from a single infectious agent. Patients live in a complex health care system with both formal and informal providers, and it is important that a TB diagnosis is not missed at the first interaction with the health care system. In this study, we highlight the health seeking behavior of patients and missed opportunities for early TB diagnosis for which interventions could be instituted to ensure early TB diagnosis and prompt TB treatment initiation. Methods: This study was nested in a cross-sectional study that assessed the accuracy of different Xpert MTB/Rif implementation strategies in programmatic settings at the referral hospitals in Uganda. We documented the symptom profile of presumptive TB patients and assessed the health seeking behavior of those with chronic cough by calculating proportion of patients that visited each type of health facility and further calculated the odds of being TB positive given the type of health facility initially visited for consultation. Results: A total of 1,863 presumptive TB patients were enrolled of which 979 (54.5%) were male, and 1795 (99.9%) had chronic cough. A total of 1352 (75.4%) had previously sought care for chronic cough, with 805 (59.6%) seeking care from a public health facility followed by private health facility (289; 21.4%). Up to 182 (13.5%) patients visited a drug store for chronic cough. Patients whose first contact was a private health facility were more likely to have a positive GeneXpert test (adjOR 1.4, 95% CI: 1.0-1.9; p = 0.047). Conclusions: Chronic cough is a main symptom for many of the presumptive TB patients presenting at referral hospitals, with several patients having to visit the health system more than once before a TB diagnosis is made. This suggests the need for patients to be thoroughly evaluated at first interface with the health care system to ensure prompt diagnosis and treatment initiation. Improved TB diagnosis possibly with the GeneXpert test, at first contact with the health care system has potential to increase TB case finding and break the transmission cycle in the community.Publisher PDFPeer reviewe
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