Browsing by Author "Ekwaro Obuku"

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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.
Working With Non-state Providers in Post-conflict and Fragile States in Primary Healthcare Service Delivery
(EPPI-Centre, 2014-10) Ekwaro Obuku; Ruth Stewart; Felix Achana; Rhona Mijumbi; Alison Kinengyere; Robert Basaza; Dickens Akena; Daniel Semakula; Richard Senono; Allen Nsangi; Boniface Mutatina; Hannington Muyenje; William Newbrander; Nelson Sewankambo
Home to at least a third of the world’s poor with the worst health indicators, post-conflict and fragile states are lagging in their efforts to achieve the Millennium Development Goals (Alliance 2008). Health services are predominantly non-state in most low-income countries, including those that have relatively effective governance, and the poorest strata of the population are more likely to use non-state providers (Palmer 2006, OECD 2006). An important area of focus for the review is to identify the role of the national government in regulating, coordinating and information sharing among public and nonstate providers, in settings where lack of regulation and organisation of health service provision are common characteristics of the health sector (Moran & Batley 2004). One of the primary reasons for supporting health service delivery in fragile states is that it is an entry point for triggering broader governance reforms (Berry et al. 2004). As such, the effectiveness of different modes of engagement and the scope of the desired outcomes are important research questions. A central theme in the literature is the dynamics between the immediate need to reduce vulnerability and achieve specific health outcomes versus longer term objectives of building sustainable health systems that promote equitable access to health. There is thus is a need for a review to address both the immediate and long term outcomes associated with health service delivery programs in fragile states (High Level Forum 2005). Despite the wealth of challenges, from poor health to extreme poverty and destroyed infrastructure, early strategic investment in the health sector during transition and postconflict periods can provide opportunities to re-align systems and introduce new service delivery models (High level Forum 2005). Effective government capacity-building to engage in essential tasks of leadership, planning, and oversight of a system based on primary care can lead to long-term returns in terms of the equity, efficiency, and effectiveness of the services provided (Macrae et al. 1996). It can also contribute to enhanced legitimacy of the state, known as the “peace dividend (Jones et al. 2006, Waldman 2006). While some researchers contend that there is too little empirical evidence of this effect to date (Rubenstein 2009), it is critical to thoroughly assess whether working with non-state actors has improved both health system capacity and health outcomes, and to examine where gaps in evidence remain.