The health system burden of chronic disease care: an estimation of provider costs of selected chronic diseases in Uganda (original) (raw)
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Readiness of Ugandan Health Services for the Management of Outpatients with Chronic Diseases
Tropical Medicine & International Health, 2015
objective Traditionally, health systems in sub-Saharan Africa have focused on acute conditions. Few data exist on the readiness of African health facilities (HFs) to address the growing burden of chronic diseases (CDs), specifically chronic, non-communicable diseases (NCDs). methods A stratified random sample of 28 urban and rural Ugandan HFs was surveyed to document the burden of selected CDs by analysing the service statistics, service availability and service readiness using a modified WHO Service Availability and Readiness Assessment questionnaire. Knowledge, skills and practice in the management of CDs of 222 health workers were assessed through a self-completed questionnaire. results Among adult outpatient visits at hospitals, 33% were for CDs including HIV vs. 14% and 4% at medium-sized and small health centres, respectively. Many HFs lacked guidelines, diagnostic equipment and essential medicines for the primary management of CDs; training and reporting systems were weak. Lower-level facilities routinely referred patients with hypertension and diabetes. HIV services accounted for most CD visits and were stronger than NCD services. Systems were weaker in lower-level HFs. Non-doctor clinicians and nurses lacked knowledge and experience in NCD care. conclusion Compared with higher level HFs, lower-level ones are less prepared and little used for CD care. Health systems in Uganda, particularly lower-level HFs, urgently need improvement in managing common NCDs to cope with the growing burden. This should include the provision of standard guidelines, essential diagnostic equipment and drugs, training of health workers, supportive supervision and improved referral systems. Substantially better HIV basic service readiness demonstrates that improved NCD care is feasible. keywords outpatients, chronic diseases, healthcare systems, health services, sub-Saharan Africa, Uganda
The determinants of health care demand in Uganda: The case study of Lira District, Northern Uganda
2006
The study investigated the price and non-price factors that affect health care demand in rural Uganda using household data from Lira district in northern Uganda, which is the poorest region. The government had introduced the user-fee scheme as a strategy for supplementing government budgets to improve health care delivery systems. The results suggested that the demand for government heath care services was negatively and significantly influenced by the user-fees and drug unavailability. A simulation analysis suggested that an increase in medical charges (user-fees) leads to a fall in demand for government health facilities but increases the demand for both private health facilities and self-medication. Controlling for drugs availability, the demand for government health facilities falls when drugs are not available while demand for private health facilities rises. The policy implication is that government should be able to put resources from things like debt relief to stocking the drugs in public health facilities while the internally generated tax revenues could be utilized to provide free health services especially to the poor. In the long run, the policy option of a social health insurance scheme may be explored.
BMC Medicine
Background Integration of health services might be an efficient strategy for managing multiple chronic conditions in sub-Saharan Africa, considering the scope of treatments and synergies in service delivery. Proven to promote compliance, integration may lead to increased economies-of-scale. However, evidence on the socio-economic consequences of integration for providers and patients is lacking. We assessed the clinical resource use, staff time, relative service efficiency and overall societal costs associated with integrating HIV, diabetes and hypertension services in single one-stop clinics where persons with one or more of these conditions were managed. Methods 2273 participants living with HIV infection, diabetes, or hypertension or combinations of these conditions were enrolled in 10 primary health facilities in Tanzania and Uganda and followed-up for up to 12 months. We collected data on resources used from all participants and on out-of-pocket costs in a sub-sample of 1531 pa...
International Journal for Equity in Health
Background: Despite the burgeoning burden of diabetes mellitus (DM) and cardiovascular diseases (CVD) in low and middle income countries (LMIC), access to affordable essential medicines and diagnostic tests for DM and CVD still remain a challenge in clinical practice. The Access to Cardiovascular diseases, Chronic Obstructive pulmonary disease, Diabetes mellitus and Asthma Drugs and diagnostics (ACCODAD) study aimed at providing contemporary information about the availability, cost and affordability of medicines and diagnostic tests integral in the management of DM and CVD in Uganda. Methods: The study assessed the availability, cost and affordability of 37 medicines and 19 diagnostic tests in 22 public hospitals, 23 private hospitals and 100 private pharmacies in Uganda. Availability expressed as a percentage, median cost of the available lowest priced generic medicine and the diagnostic tests and affordability in terms of the number of days' wages it would cost the least paid public servant to pay for one month of treatment and the diagnostic tests were calculated. Results: The availability of the medicines and diagnostic tests in all the study sites ranged from 20.1% for unfractionated heparin (UFH) to 100% for oral hypoglycaemic agents (OHA) and from 6.8% for microalbuminuria to 100% for urinalysis respectively. The only affordable tests were blood glucose, urinalysis and serum ketone, urea, creatinine and uric acid. Parenteral benzathine penicillin, oral furosemide, glibenclamide, bendrofluazide, atenolol, cardiac aspirin, digoxin, metformin, captopril and nifedipine were the only affordable drugs. Conclusion: This study demonstrates that the majority of medicines and diagnostic tests essential in the management of DM and CVD are generally unavailable and unaffordable in Uganda. National strategies promoting improved access to affordable medicines and diagnostic tests and primary prevention measures of DM and CVD should be prioritised in Uganda.
2020
Background: Availability of essential medicines for non-communicable diseases (NCDs) is poor in low- and middle-income countries. Availability and cost are conventionally assessed using cross-sectional data. However, these characteristics may vary over time. Methods: We carried out a prospective, descriptive analysis of the availability and cost of essential medicines in 23 Ugandan health facilities over a five-week period. We surveyed facility pharmacies in-person up to five times, recording availability and cost of 19 essential medicines for NCDs and four essential medicines for communicable diseases. Results: Availability of medicines varied substantially over time, especially among public facilities. Among private-for-profit facilities, the cost of the same medicine varied from week to week. Private-not-for-profit facilities experienced less dramatic fluctuations in price. Conclusions: We conclude that there is a need for standardized, continuous monitoring to better characteriz...
Journal of Pharmaceutical Policy and Practice, 2015
A key policy question for the government of Uganda is how to equitably allocate primary health care pharmaceutical budgets to districts. This paper seeks to identify variables influencing current primary health care pharmaceutical expenditure and their usefulness in allocating prospective pharmaceutical budgets to districts. Methods: This was a cross sectional, retrospective observational study using secondary administrative data. We collected data on the value of pharmaceuticals procured by primary health care facilities in each district from National Medical Stores for the financial year 2011/2012. The dependent variable was expressed as per capita district pharmaceutical expenditure. By reviewing literature we identified 26 potential explanatory variables. They include supply, need and demand, and health system organization variables that may influence the demand and supply of health services and the corresponding pharmaceutical expenditure. We collected secondary data for these variables for all the districts in Uganda (n = 112). We performed econometric analysis to estimate parameters of various regression models. Results: There is a significant correlation between per capita district pharmaceutical expenditure and total district population, rural poverty, access to drinking water and outpatient department (OPD) per capita utilisation.(P < 0.01). The percentage of health centre IIIs (HC III) among each district's health facilities is significantly correlated with per capita pharmaceutical expenditure (P < 0.05). OPD per capita utilisation has a relatively strong correlation with per capita pharmaceutical expenditure (r = 0.498); all the other significant factors are weakly correlated with per capita pharmaceutical expenditure (r < 0.5). From several iterations of an initially developed model, the proposed final model for explaining per capita pharmaceutical expenditure explains about 53% of the variation in pharmaceutical expenditure among districts in Uganda (Adjusted R 2 = 0.528). All variables in the model are significant (p < 0.01). Conclusions: From evaluation of the various models, proposed variables to consider in allocating prospective primary health care pharmaceutical budgets to districts in Uganda are: district outpatient department attendance per capita, total district population, total number of government health facilities in the district and the district human poverty index.
While health service utilization is a key indicator of health service delivery which many countries seek to improve, low health service utilisation patterns characterize urban settings in developing countries with a grave impact on the community. One such urban setting is Mbale Municipality in Mbale district, Uganda. A cross sectional descriptive study was carried in five wards of Mbale Municipality on the nine three (93) respondents. The study aimed at investigating the determinants which influence utilization of health services in urban areas. The information was collected using questionnaires and semi structured interviews. The study findings showed that the procurement process resulted in delayed and inadequate supply of essential drugs and medical equipment' supply. Understaffing is inadequate and untimely funding was also reported. Poor medical ethic or code of conduct of the health workers and negative perceptions of the community towards health services and health staff were cited as other influencing determinants to health services utilisation in urban areas. In view of these findings, the authors propose a review of the procurement system to ensure timely and adequate supply of drugs and medical equipment, recruitment of more health staff, continuous professional development (CPD) of health workers in medical ethical code of conduct in handling patients, sensitization of the community to build trust on health workers, and sharing of responsibilities by couples while taking care of patients in admission.
BMJ Open
ObjectiveTo evaluate the costs and client outcomes associated with integrating screening and treatment for non-communicable diseases (NCDs) into HIV services in a rural and remote part in southeastern Africa.DesignProspective cohort study.SettingPrimary and secondary level health facilities in Neno District, Malawi.ParticipantsNew adult enrollees in Integrated Chronic Care Clinics (IC3) between July 2016 and June 2017.Main outcome measuresWe quantified the annualised total and per capita economic cost (US$2017) of integrated chronic care, using activity-based costing from a health system perspective. We also measured enrolment, retention and mortality over the same period. Furthermore, we measured clinical outcomes for HIV (viral load), hypertension (controlled blood pressure), diabetes (average blood glucose), asthma (asthma severity) and epilepsy (seizure frequency).ResultsThe annualised total cost of providing integrated HIV and NCD care was $2 461 901 to provide care to 9471 enr...
Private and public health care in rural areas of Uganda
BMC International Health and Human Rights, 2010
Background: In many low and middle income countries, the private sector is increasingly becoming an important source of health care, filling gaps where no or little public health care is available. However, knowledge on the private sector providers is limited The objective of this study was to determine the type and number of different types of health care providers, and the quality, cost and utilization of care delivered by those providers in rural Uganda.
Financing and delivery of health services in Eastern and Southern Africa
1997
adjustment is a cut in public spending on social services including health services. The government of Uganda has introduced cost-sharing as one way of achieving this objective. However cost-sharing is frustrating to implement in a country where information regarding the costs in real terms of the health care services is lacking and where the response of the citizens to flscal measures is not high on the priority list of policy makers These two conditions make it impossible for the merits of alternatives to government health services to be easily mapped, and subsequently masks fiscal abilities and preferences of Citizens. Government support for social services• principally health and education has declined radically from the early 1970's. The deterioration of the health service system in Uganda is partly attributable to the complex ethnic legacy of colonial rule which helped to push the country into political, economic and social turmoil from which it may only now slowly be recovering. The effects of the turmoil on service provision were devastating. As a resifit of this Uganda's aggregate health indicators, today, such as infant mortality and life expectancy at birth are among the world's worst. Government's capacity to deliver social services is further hampered by a low revenue base and therefore low resources available to government for expenditure on social services. This is further exacerbated by an ineffectual prioritisation, lack of a "living wage" for government employees and extremely low rural incomes. This forms the backdrop to state capacity to provide services.. Public sector support for improved services cannot be matched by adequate budgeting allocation-while government is financing the strengthening of the economic base. There are significant systemic and structural inequalities in both the emplacement of facilities and accessibility to health services in Uganda: between urban and rural areas and within them. Almost all public facilities are in a sorry state. There exists little effective management and the staff are inadequately jaid The management issue is partly a matter of training but mainly one of motivation. it is also a reflection of the poorly coordinated structure of responsibility for health services in Uganda 6