Project title: Assessment of the Extent to which Resources Allocated to the Health Facilities Affect Access to Essential Medicines in Uganda.
This is a three year project funded by the Results for Development Institute Inc (R4D) under the transparency and accountability Programme (TAP). It has research and advocacy components which are intended to improve accountability for health expenditures and health service delivery. Its goal is to improve the effectiveness of public spending and service delivery. It is jointly implemented by UNHCO and HEPS-Uganda in Bushenyi and Lira districts respectively.
The project has so far been operational for two years during which a Quantitative Service Delivery Survey (QSDS) and Citizen Report Card have been conducted. The 3rd year involves implementation of the Community Score Card augmented with continued advocacy at community, district and national levels.
The QSDS focused on the service provider perspective.
Key findings of the QSDS included (full report at - http://unhco.or.ug/library/?did=17):
- Infrastructure for health service delivery is not available at lower levels while in higher level health facilities is inadequate due high patient loads
- Newly constructed health facilities especially HC IIs and IVs are not put to use immediately because of lack of staff and equipment
- Inadequate storage facilities for medicines
- There is acute lack of lighting in the facilities; less than ¾ of thefacilities were connected to electricity and most of them were disconnected.
- Health financing still remains low in all districts with unfinanced gaps.
On the other hand, the Citizens’ Report Card (CRC) provides perceptions of healthcare users on service accessibility, availability and quality at selected health facilities in the districts of Bushenyi and Lira.
The key findings of the CRC study are:
- Majority of the household respondents in Bushenyi were satisfied with level of accessibility of health services compared to their counterparts in Lira district.
- Majority of users in either district were satisfied with the distance to the nearest health facility.
- However, users were dissatisfied with the late opening of health centres and the time spent at the health facility waiting to be attended to by health workers.
- Majority of the household respondents (79% in Bushenyi and 68% in Lira) visited health facilities seeking treatment. The other reasons were consultations, ante-natal care and others, in this order. The other reasons herein were reviews, immunisation, and family planning.
- 85% of the users in Bushenyi district and 61% in Lira district received the required service. 15% of the users in Bushenyi district and 39% in Lira district could not access the service they needed. services were more available in Bushenyi district than in Lira district.
- The proportion of respondents that reported availability of medicines was higher in Bushenyi compared to Lira.
- More respondents in Bushenyi district were satisfied with the client-health worker interaction at health facility level compared to those in lira
- over 70% of consumers are not aware of complaint redress structures
- MoH and NMS should take into consideration patient load and local epidemiological data in the composition of kits for different health centres. In the event that the kit based system proves problematic, MoH/NMS should consider reverting to the pull system for supplying EMHS accompanied with a tailor-made capacity building program for HC In-charges
- It is also important to strengthen the capacity of health facilities to carryout diagnosis by providing the necessary laboratory equipment, supplies and staff.
- It is the obligation of health users to seek drugs only when they are ill to minimize stock-outs for the genuine patients.
- MoH and DLGs should strengthen the mangt of capacity development programs for health workers, ensuring that a specific proportion of district/health facility staff can be allowed to benefit from study leave in a given year. They ought to coordinate better with HUMC and In-charges in deciding on staff to be granted study leave. Motivation schemes would attract and retain qualified staff in rural based facilities which are currently headed by junior health cadres.
- MoH and DLG should expand and or improve on the existing health centre infrastructure and facilities such as wards, laboratory, transport, energy, sources, staff houses. These will ensure that all health facilities are functional, utilize the resources already invested and reduce patient overload in the referral health facilities.
- Health users should be educated about the services offered at the different levels of health facilities to avoid disappointments resulting from high expectations.
- The ministry of health and district local governments should strengthen monitoring and supervision of health facilities and ensure adherence to the duty roster and health service standards, including time management.