UCU Digital Institutional Repository(UCUDIR)

Welcome to the Uganda Christian University Digital Institutional Repositoy (UCUDIR). This is the University's official Institutional Repository. It aims to collect, preserve and showcase the intellectual output of staff and students of UCU. This growing collection of research includes peer-reviewed articles, book chapters, working papers, theses, and more.

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A National Framework for Sustainability of Health Knowledge Translation Initiatives in Uganda
(Uganda Country Node of the Regional East African Community Health Policy Initiative, 2014-05-26) Robert Basaza; Alison Annet Kinengyere; Nelson Sewankambo
This report is intended to inform the deliberations of those engaged in developing policies on sustainability of health knowledge translation initiatives policies as well as other stakeholders with an interest in such policy decisions. It summarizes the best available evidence regarding the design and implementation of policies on how to advance sustainability of health knowledge translation initiatives policies in Uganda’s [mainstream] health system. The purpose of the report is not to prescribe or proscribe specific options or implementation strategies. Instead, the report allows stakeholders to consider the available evidence about the likely impacts of the different options systematically and transparently.
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Willingness to Pay for Community Health Insurance Among Taxi Drivers in Kampala City, Uganda: A Contingent Evaluation
(Risk Management and Healthcare Policy, 2019) Robert Basaza; Elizabeth P Kyasiimire; Prossy K Namyalo; Angela Kawooya; Proscovia Nnamulondo; Kon Paul Alier
Background: Community Health Insurance (CHI) schemes have improved the utilization of health services by reducing out-of-pocket payments (OOP). This study assessed income quintiles for taxi drivers and the minimum amount of premium a driver would be willing to pay for a CHI scheme in Kampala City, Uganda. Methods: A cross-sectional study design using contingent evaluation was employed to gather primary data on willingness to pay (WTP). The respondents were 312 randomly and 9 purposively selected key informants. Qualitative data were analyzed using conceptual content analysis while quantitative data were analyzed using MS Excel 2016 to generate the relationship of socio-demographic variables and WTP. Results: Close to a half (47.9%) of the respondents earn above UGX 500,000 per month (fifth quintile), followed by 24.5% earning a monthly average of UGX 300,001–500,000 and the rest (27.5%) earn less. Households in the fourth and fifth quintiles (38.4% and 20%, respectively) are more willing to join and pay for CHI. A majority of the respondents (29.9%) are willing to pay UGX, 6,001–10,000 while 22.3% are willing to pay between UGX 11,001 and UGX 20,000 and 23.2% reported willing to pay between UGX 20,001 and UGX 50,000 per person per month. Only 18.8% of the respondents recorded WTP at least UGX 5,000 and 5.8% reported being able to pay above UGX 50,000 per month (1 USD=UGX 3,500). Reasons expressed for WTP included perceived benefits such as development of health care infrastructure, risk protection, and reduced household expenditures. Reasons for not willing to pay included corruption, mistrust, inadequate information about the scheme, and low involvement of the members. Conclusion: There is a possibility of embracing the scheme by the taxi drivers and the rest of the informal sector of Uganda if the health sector creates adequate awareness.
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Assessment Uganda Health System Pre-assessment Report 2016
(United States Agency for International Development/Uganda, 2016-08) Sebastian Olikira Baine; Robert Basaza; Beth Ann Pratt
The 2011-2015 USAID/Uganda Country Development Cooperation Strategy (CDCS 1.0) hypothesized that a structurally sound, well-resourced, functioning health system, supporting access to quality service delivery is essential to ensuring effective utilization of health services and subsequently, to improving health outcomes in Uganda (USAID, 2010). Therefore, as USAID/Uganda approaches the end of implementation of CDCS 1.0 and in preparation for the next CDCS, it is important to understand the changes that have occurred in the elements of the system and elements that currently comprise Uganda’s national health system, the relationships and interdependencies between these elements, and the fiscal, political, economic, social, and multi-sectoral factors and stakeholders that influence and impact the system’s functionality. The World Health Organization defines a health system as “all organizations, people and actions whose primary intent is to promote, restore or maintain health,” the purpose of which is to improve access and coverage of responsive, efficient, effective, equitable, and quality-driven health services (WHO, 2000). To this end, a health system is supported by a set of basic building blocks - including human resources, financing, information systems, medical supply chains, governance mechanisms, and ervice delivery structures - linked to quality assurance mechanisms, all of which serve to uphold the health sector’s responsibility and accountability to both patients and their communities (Figure 1). For diagrammatic purposes, health systems frameworks often present these building blocks as parallel, stand-alone pillars. In practice, however, elements of a health system are mutually derivative and reinforcing.
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Players and Processes Behind the National Health Insurance Scheme: A Case Study of Uganda
(BMC Health Services Research, 2013) Robert K Basaza; Thomas S O’Connell; Ivana Chapčáková
Background: Uganda is the last East African country to adopt a National Health Insurance Scheme (NHIS). To lessen the inequitable burden of healthcare spending, health financing reform has focused on the establishment of national health insurance. The objective of this research is to depict how stakeholders and their power and interests have shaped the process of agenda setting and policy formulation for Uganda’s proposed NHIS. The study provides a contextual analysis of the development of NHIS policy within the context of national policies and processes. Methods: The methodology is a single case study of agenda setting and policy formulation related to the proposed NHIS in Uganda. It involves an analysis of the real-life context, the content of proposals, the process, and a retrospective stakeholder analysis in terms of policy development. Data collection comprised a literature review of published documents, technical reports, policy briefs, and memos obtained from Uganda’s Ministry of Health and other unpublished sources. Formal discussions were held with ministry staff involved in the design of the scheme and some members of the task force to obtain clarification, verify events, and gain additional information. Results: The process of developing the NHIS has been an incremental one, characterised by small-scale, gradual changes and repeated adjustments through various stakeholder engagements during the three phases of development: from 1995 to 1999; 2000 to 2005; and 2006 to 2011. Despite political will in the government, progress with the NHIS has been slow, and it has yet to be implemented. Stakeholders, notably the private sector, played an important role in influencing the pace of the development process and the currently proposed design of the scheme. Conclusions: This study underscores the importance of stakeholder analysis in major health reforms. Early use of stakeholder analysis combined with an ongoing review and revision of NHIS policy proposals during stakeholder discussions would be an effective strategy for avoiding potential pitfalls and obstacles in policy implementation. Given the private sector’s influence on negotiations over health insurance design in Uganda, this paper also reviews the experience of two countries with similar stakeholder dynamics.
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The Cost of Routine Immunization Services in a Poor Urban Setting in Kampala, Uganda: Findings of a Facility-Based Costing Study
(Journal of Immunological Sciences, 2018-07-03) Isaiah Chebrot; Annet Kisakye; Brendan Kwesiga; Daniel Okello; Diana Kiiza; Eva Kabwongera; Robert Basaza
Background: Reducing infant and under-five mortality by use of cost-effective strategies like immunization continues to be a challenge, particularly in resource limited settings. Strategic planning for immunization requires credible costing information to estimate available funding, allocate funds within the program and avoid funding shortfalls. This study assessed the total and unit costs of providing routine immunization in health facilities in Kampala. Methods: This was a retrospective descriptive cost analysis study that applied a bottom-up, ingredients-based costing methodology which identified costs from the perspective of the health service providers. The cost of providing immunization services in health facilities in Kawempe Division in the financial year 2015/2016 was determined using relevant data which was collected using an Excel questionnaire adapted from the CostIt software of the World Health Organization. The analysis was also based on the same CostIt software. Results: The average total facility immunization costs were USD 14,415.1 with a range of 8,205.3 at private for profit to USD 47,094.9 at public health facilities. Vaccines and supplies were the main cost driver accounting for 63.6% followed by personnel costs at 24.0%. Routine facility based immunization had the highest cost with an average of 47.9% followed by outreach services at 32.3%. The average cost per dose administered was USD 1.4 with a range of USD 1.0 in larger health centres (HCIV) to 1.5 in HCIII (medium-sized HC or dispensary). The average cost per DPT3 immunized child was USD 20.0 with a range of USD 12.6 in HCIV to 22.0 in HCIII. The findings show a great variance between facility ownership and levels. Conclusions: The study found that the recurrent costs were significantly higher than capital costs and this was across all facilities. Vaccines and personnel costs were the two main cost drivers. Routine facility based immunization was the costliest activity followed by outreaches with social mobilization being the least. The cost per dose administered and DPT3 immunized child were dependent on outputs with high output health facilities having less unit costs compared to facilities with less out outputs. Private health facilities had higher unit costs compared to publicly owned health facility.
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Identifying and Characterising Health Policy and System-Relevant Documents in Uganda: A Scoping Review to Develop a Framework for the Development of a One-Stop Shop
(Healthy Research Policy and Systems, 2017) Boniface Mutatina; Robert Basaza; Ekwaro Obuku; John N. Lavis; Nelson Sewankambo
Background: Health policymakers in low- and middle-income countries continue to face difficulties in accessing and using research evidence for decision-making. This study aimed to identify and provide a refined categorisation of the policy documents necessary for building the content of a one-stop shop for documents relevant to health policy and systems in Uganda. The on-line resource is to facilitate timely access to well-packaged evidence for decision-making. Methods: We conducted a scoping review of Uganda-specific, health policy, and systems-relevant documents produced between 2000 and 2014. Our methods borrowed heavily from the 2005 Arksey and O’Malley approach for scoping reviews and involved five steps, which that include identification of the research question; identification of relevant documents; screening and selection of the documents; charting of the data; and collating, summarising and reporting results. We searched for the documents from websites of relevant government institutions, non-governmental organisations, health professional councils and associations, religious medical bureaus and research networks. We presented the review findings as numerical analyses of the volume and nature of documents and trends over time in the form of tables and charts. Results: We identified a total of 265 documents including policies, strategies, plans, guidelines, rapid response summaries, evidence briefs for policy, and dialogue reports. The top three clusters of national priority areas addressed in the documents were governance, coordination, monitoring and evaluation (28%); disease prevention, mitigation, and control (23%); and health education, promotion, environmental health and nutrition (15%). The least addressed were curative, palliative care, rehabilitative services and health infrastructure, each addressed in three documents (1%), and early childhood development in one document. The volume of documents increased over the past 15 years; however, the distribution of the different document types over time has not been uniform. Conclusion: The review findings are necessary for mobilising and packaging the local policy-relevant documents in Uganda in a one-stop shop; where policymakers could easily access them to address pressing questions about the health system and interventions. The different types of available documents and the national priority areas covered provide a good basis for building and organising the content in a meaningful way for the resource.
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Utilization of Health Insurance by Patients With Diabetes or Hypertension in Urban Hospitals in Mbarara, Uganda
(Plos Global Public Health, 2023-06-14) Peter Kangwagye; Laban Waswa Bright; Gershom Atukunda; Robert Basaza; Francis Bajunirwe
Background Diabetes and hypertension are among the leading contributors to global mortality and require life-long medical care. However, many patients cannot access quality healthcare due to high out-of-pocket expenditures, thus health insurance would help provide relief. This paper examines factors associated with utilization of health insurance by patients with diabetes or hypertension at two urban hospitals in Mbarara, southwestern Uganda. Methods We used a cross-sectional survey design to collect data from patients with diabetes or hypertension attending two hospitals located in Mbarara. Logistic regression models were used to examine associations between demographic factors, socio-economic factors and awareness of scheme existence and health insurance utilization. Results We enrolled 370 participants, 235 (63.5%) females and 135 (36.5%) males, with diabetes or hypertension. Patients who were not members of a microfinance scheme were 76% less likely to enrol in a health insurance scheme (OR = 0.34, 95% CI: 0.15–0.78, p = 0.011). Patients diagnosed with diabetes/hypertension 5–9 years ago were more likely to enrol in a health insurance scheme (OR = 2.99, 95% CI: 1.14–7.87, p = 0.026) compared to those diagnosed 0–4 years ago. Patients who were not aware of the existing schemes in their areas were 99% less likely to take up health insurance (OR = 0.01, 95% CI: 0.0–0.02, p < 0.001) compared to those who knew about health insurance schemes operating in the study area. Majority of respondents expressed willingness to join the proposed national health insurance scheme although concerns were raised about high premiums and misuse of funds which may negatively impact decisions to enrol. Conclusion Belonging to a microfinance scheme positively influences enrolment by patients with diabetes or hypertension in a health insurance program. Although a small proportion is currently enrolled in health insurance, the vast majority expressed willingness to enrol in the proposed national health insurance scheme. Microfinance schemes could be used as an entry point for health insurance programs for patients in these settings.
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Factors Influencing Cigarette Smoking Among Police and Costs of an Officer Smoking in the Workplace at Nsambya Barracks, Uganda
(Tobacco Prevention & Cessation, 2020-01-06) Robert Basaza; Mable M. Kukunda; Emmanuel Otieno; Elizabeth Kyasiimire; Hafisa Lukwata; Christopher K. Haddock
INTRODUCTION Studies in several countries indicate that being a police officer is a risk factor for tobacco use. Currently, no such studies have been performed among police officers in Uganda, or in Africa generally. The aim of this study is to assess prevalence and costs of smoking among Ugandan police officers. METHODS A multistage survey model was employed to sample police officers (n=349) that included an observational cross-sectional survey and an annual cost-analysis approach. The study setting was confined to Nsambya Police Barracks, in Kampala city. RESULTS Police officers smoke 4.8 times higher than the general public (25.5% vs 5.3%). Risk factors included lower age, higher education and working in guard and general duties units. The findings show that the annual cost of smoking due to productivity loss could be up to US$5.521 million and US$57.316 million for excess healthcare costs. These costs represent 45.1% of the UGX514.7 billion (in Ugandan Shillings, or about US$139.1 million) national police budget in the fiscal year 2018–19 and is equivalent to 0.24% of Uganda’s annual gross domestic product (GDP). CONCLUSIONS Considering these data, prevalence of smoking among police officers are dramatically higher than in the general population. Consequently, smoking in police officers exerts a large burden on healthcare and productivity costs. This calls for comprehensive tobacco control measures designed to reduce smoking in the workplace so as to fit the specific needs of the Ugandan Police Force.
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Factors Influencing Cigarette Smoking Among Soldiers and Costs of Soldier Smoking in the Work Place at Kakiri Barracks
(HHS Public Access, 2017-05) Robert Basaza; Emmanuel Otieno; Ambrose Musinguzi; Possy Mugyenyi; Christopher K. Haddock
Background: Although Uganda has a relatively low prevalence of smoking, no data exists on cigarette use among military personnel. Studies in other countries suggests military service is a risk factor for tobacco use. Objectives: To assess prevalence and risk factors for and costs of smoking among military personnel assigned to a large military facility in Uganda. Design: A mixed methods study including focus groups, interviews, and a cross-sectional survey of military personnel. Setting: Kakiri Barracks, Uganda Subjects: Key informants and focus group participants were purposively selected based on the objectives of the study, military rank and job categories. A multi stage sample design was used to survey individuals serving in Uganda People’s Defense Forces (UPDF) from June-November 2014 for the survey (n = 310). Results: Participants in the qualitative portion of the study reported that smoking was harmful to health and the national economy and that its use was increasing among UPDF personnel. Survey results suggested that smoking rates in the military were substantially higher than in the general public (i.e., 34.8% vs. 5.3%). Significant predictors of smoking included lower education, younger age, having close friends who smoked and a history of military deployment. Estimated costs of smoking due to lost productivity was US$576,229 and US$212,400 for excess healthcare costs. Conclusion: Smoking rates are substantially higher in the UPDF compared to the general public and results in significant productivity costs. Interventions designed to reduce smoking among UPDF personnel should be included in the country’s national tobacco control plan.
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Feasibility and Desirability of Scaling Up Community–Based Health Insurance (CBHI) in Rural Communities in Uganda: Lessons From Kisiizi Hospital CBHI Scheme
(BMC Health Sciences Research, 2020) Alex A. Kakama; Prossy K. Namyalo; Robert K. Basaza
Background: Community-based Health Insurance (CBHI) schemes have been implemented world over as initial steps for national health insurance schemes. The CBHI concept developed out of a need for financial protection against catastrophic health expenditures to the poor after failure of other health financing mechanisms. CBHI schemes reduce out-of-pocket payments, and improve access to healthcare services in addition to raising additional revenue for the health sector. Kisiizi Hospital CBHI scheme which was incepted in 1996, has 41,500 registered members, organised in 210 community associations known as ‘Bataka’ or ‘Engozi’ societies. Members pay annual premiums and a co-payment fee before service utilisation. This study aimed at exploring the feasibility and desirability of scaling up CBHI in Rubabo County, with specific objectives of: exploring community perceptions and determining acceptability of CBHI, identifying barriers, enablers to scaling up CBHI and documenting lessons regarding CBHI expansion in a rural community. Methods: Explorative study using qualitative methods of Key informant interviews and Focus Group Discussions (FGDs). Seventeen key informant interviews, three focus group discussions for scheme members and three for non- scheme members were conducted using a topic guide. Data was analysed using thematic approach. Results: Scaling up Kisiizi Hospital CBHI is desirable because: it conforms to the government social protection agenda, society values, offers a comprehensive benefits package, and is a better healthcare financing alternative for many households. Scaling up Kisiizi Hospital CBHI is largely feasible because of a strong network of community associations, trusted quality healthcare services at Kisiizi Hospital, affordable insurance fees, trusted leadership and management systems. Scheme expansion faces some obstacles that include: long distances and high transport costs to Kisiizi Hospital, low levels of knowledge about health insurance, overlapping financial priorities at household level and inability of some households to pay premiums. Conclusions: CBHI implementation requires the following considerations: conformity with society values and government priorities, a comprehensive benefits package, trusted quality of healthcare services, affordable fees, trusted leadership and management systems.