Browsing by Author "Robert Basaza"

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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.
Assessment of Needle Stick Injuries Among Healthcare Workers: A Cross-Sectional Study From Kakiri Military and SOS Hospitals, Uganda
(International Journal of Healthcare, 2021-12-07) Robert Basaza; Otieno Emmanuel; Christopher Keith Haddock
The Ugandan military medical services work together with the civilian public health system to deliver quality healthcare. This Partnership is the mainstay of health service delivery in Uganda. The burden of needle stick injuries (NSIs) is increasing in Uganda’s larger health industry; however, data on needle stick injury in military and public health facilities is lacking. No published data exist on comparative studies for a mix of facilities both military and civilian health settings. This study represents the first time this issue has been studied in a military or public health hospital in Uganda. A hospital-based, cross-sectional study was conducted in July 2018 to September 2019 in Kakiri Military and SOS Hospitals in Uganda using a structured questionnaire. Respondents were purposively selected based on the objectives of study, occupation status and department (N = 310). The overall prevalence of NSIs among respondents was 27.2% and prevalence rates for the two facilities was nearly identical. The largest percentage of NSIs occurred during drawing venous blood samples (49.4%). Significant predictors of NSI were gender, occupational status, age, poor knowledge on prevention and post exposure of NSI, and less professional experience. Infection control practices were lacking in both selected health facilities. Over a quarter of HCWs in Uganda reported NSIs, which places them at significant health risk. Fostering the practice of universal precautions, best infection control practices and training of healthcare workers on bio-safety measures can reduce the prevalence of NSIs.
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.
Community Health Insurance (CHI) in Sub-saharan Africa: Researching the Context
(Blackwell Publishing, 2025-06-27) Bart Criel; Chris Atim; Robert Basaza; Pierre Blaise; Maria Pia Waelkens
Community Health Insurance (CHI) is a general term for voluntary health insurance schemes organized at community level, that are alternatively known as mutual health organizations (or mutuelles de sante ´ in French) (Atim 1999), medical aid societies (Atim 1999), medical aid schemes (van den Heever 1997) or micro-insurance schemes (Dror & Jacquier 1999). The common characteristics are that they are run on a non-profit basis and they apply the basic principle of risk-sharing. The last two decades have seen an apparent boom in CHI in sub Saharan Africa, in terms of the sheer number of such initiatives and the increasing attention that some policy makers and development partners are paying to these ventures.1 The rationale for the current wave of promotion of CHI in Africa is based on two main factors. First, the recognition that for African households, financial accessibility to quality health care is a strongly felt need. Second, the success of the Western European experience social health insurance, initiated through small CHI schemes at the end of the 19th and beginning of the 20th century (Ba¨rnig hausen & Sauerborn 2002), suggesting that the financing of health care based on pooling of resources and risk sharing may constitute a relevant policy option for African health care systems.
Community Health Insurance in Uganda: Status, Obstacles and Prospects
(Afrika focus, 2011-05-19) Robert Basaza; Patrick Van der Stuyft; Bart Criel
The aim of this thesis is to contribute to the understanding of CHI, both in general and in Uganda specifically. The general objective is to investigate the obstacles and prospects for CHI schemes in Uganda. The specific objectives are: (1) to study demand and supply side factors to explain the low levels of enrolment in existing CHI schemes; (2) to investigate the perceptions of CHI held by those enrolled and those not enrolled in the schemes; (3) to determine knowledge, understanding and perceptions of the relevance of CHI among policy-makers and health service managers; and (4) to formulate evidencebased policy recommendations for the Ugandan health sector_We set the stage for this research by using secondary data sources to embark on a review of the context of CHI schemes in sub-Saharan Africa. Results indicate that the coverage rates of the target population remain low. Other findings suggest that there are five dimensions that seem to be relevant within the framework of the development of CHI: political, economic, social, technical and managerial contexts. We acknowledged the need for more contextualised analyses of both successful and less successful schemes to enhance our collective understanding of why CHI works in certain circumstances and why it fails in others. Therefore, we set out to investigate in detail the emerging features of CHI schemes in East Africa. Schemes from three East African countries (Uganda, Kenya and Tanzania) were examined using a grid to analytically tabulate their features. The key descriptive findings are as follows: (1) the schemes' coverage within their catchment areas was small; (2) the schemes had been in existence for only a short time; (3) they were established with donor support; and (4) they provided both inpatient and outpatient benefits. The findings of this study underscore the role of the government in the promotion of CHI. This is especially true for advocacy, as the government must pay the premiums for the poorest citizens and develop an enabling policy and legal framework. We also concluded that there is a need for primary data to understand the mix of factors involved in CHI schemes.
Community Health Insurance in Uganda: Why Does Enrolment Remain Low? A View From Beneath
(Elsevier, 2008) Robert Basaza; Bart Criel; Patrick Van der Stuyft
Community Health Insurance (CHI) in Uganda faces low enrolment despite interest by the Ugandan health sector to have CHI as an elaborate health sector financing mechanism. User fees have been abolished in all government facilities and CHI in Uganda is limited to the private not for profit sub-sector, mainly church-related rural hospitals. In this study, the reasons for the low enrolment are investigated in two different models of CHI. Focus group discussions and in-depth interviews were carried out with members and non-members of CHI schemes in order to acquire more insight and understanding in people’s perception of CHI, in their reasons for joining and not joining and in the possibilities they see to increase enrolment. This study, which is unprecedented in East Africa, clearly points to a mixed understanding on the basic principles of CHI and on the routine functioning of the schemes. The lack of good information is mentioned by many. Problems in ability to pay the premium, poor quality of health care, the rigid design in terms of enrolment requirements and problems of trust are other important reasons for people not to join. Our findings are grossly in line with the results of similar studies conducted in West Africa even if a number of context-specific issues have been identified. The study provides relevant elements for the design of a national policy on CHI in Uganda and other sub-Saharan countries.
Determinants of Breast Cancer Screening Among Reverend Sisters in Kampala Archdiocese, Uganda: A Cross-Sectional Study
(Archives of Breast Cancer, 2022-02-13) Judith Kaddua; Robert Basaza; Emmanuel Otieno; Florence Mirembe
Background: Breast cancer in Uganda is the second commonest cancer in women coming only next to cancer of the cervix. This is the first cross-sectional study to investigate the determinants of self-breast cancer screening among Reverend Sisters in Kampala, the largest Archdiocese of Roman Catholic Church in Uganda. The prevention strategies in this country are still not optimal and the key to prevention is breast screening. Methods: A cross-sectional analytical study was conducted from September, 2018 to June, 2019. A sample of 310 respondents were interviewed using a semi-structured, self- administered questionnaire. Data was analyzed using logistic regression model. Results: A majority (96.4%) of the respondents did not do a mammography, 54.1% never practiced breast self-examination (BSE) and 34.2% performed it regularly during bedtime. The reasons for performing BSE included: curiosity (61.9%), having a lump (19%) and carrying out screening (9.5%). Significant predictors of breast cancer screening were ordinary level of education (11 years of education), hearing about breast cancer, different screening methods, and symptoms of breast cancer, usefulness of screening for women, a need for sisters to screen, self-breast examination and mammography. Age and other levels of education were not significantly associated with breast cancer screening. Conclusion: The Reverend Sisters had a low level of knowledge and a small fraction practiced breast cancer screening. This demands a sustainable interventional strategy of breast health awareness campaign, establishment of appropriate health infrastructure related to precision oncology in Uganda and similar settings.
Estimating the Impact of Maternal Health Services on Maternal Mortality in Uganda
(2004-03-01) Lori Bollinger; Robert Basaza; Chris Mugarura; John Ross; Koki Agarwal
The Government of Uganda recognizes that its population is its most valuable asset and is an integral component of the development process. The development goals are therefore geared towards the improvement of the quality of life of its population. Indeed, improving the quality of life is one of the four pillars of the Poverty Eradication Plan of the Government of Uganda. High fertility, maternal and infant morbidity and mortality, however, hamper the attainment of these goals. Currently in Uganda, the maternal mortality ratio (MMR) is recorded at 505:100,000 live births, the infant mortality rate (IMR) is 88:1,000 live births, the total fertility rate (TFR) is 6.9 births, and the contraceptive prevalence rate (CPR) is 23%. The major cases of maternal morbidity and mortality are preventable. One of the major strategies for reducing infant and maternal mortality and fertility is ensuring access to quality integrated Reproductive Health services, (Five Year Health Sector Strategic Plan 2000- 2005 and UDHS 2000/2001). Because of its commitment to addressing these issues, the Ministry of Health for Uganda requested an application of the Safe Motherhood model. Collaboration was established with the Population Secretariat, of the Ministry of Finance, Planning and Economic Development. Technical and financial assistance were sought from the Futures Group/USAID in execution of this undertaking.
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.
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.
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.
Lifestyle Factors Accelerating Ageing of PLHIV in the Art Clinics of Kampala, Uganda
(American Journal of Medical and Clinical Research & Reviews, 2023-11-05) Peter S. Kirabira; Florence Nakaggwa; Robert Basaza
Introduction Ageing is an un-avoidable and natural phenomenon of life, but with modified lifestyle, physical and cognitive function and the quality of life of a person living with HIV can help them live a quality ageing life while on ART. This study sought to understand a range of geriatric lifestyle factors that accelerate ageing among HIV-infected persons who are actively on ART in Makindye Division in Uganda. Specifically, we assessed how smoking, alcohol consumption, physical activity and body weight control accelerated ageing in this category of patients. Methods This was a descriptive cross-sectional study involving PLHIV actively on ART aged 45 and above in public and faith-based healthcare facilities in Makindye Division, the highest populated in Kampala District. 478 participants were sampled from Nsambya Hospital, Kiruddu Hospital and Ggaba Fishing Community ART clinic. Data collectors were trained, a pre-testing done, and data was exported to STATA for analysis. Results Running (p=0.044) and exercise bike (0.043) were the only factors associated with ageing in the multi-variate model. Neither smoking nor alcohol consumption had a statistically significant association with ageing; recreational drug use was also not associated with ageing. requency of physical exercise (p=0.021), engaging in running (p=0.046) or exercise bike (p=0.027) as a physical activity had a statistically significant association with ageing. Only perception of overweight status had a statistically significant association with ageing among this study population (p=0.016). Conclusion In conclusion, exercising only 1-2 times a month is a risk factor to accelerated ageing for a PLHIV aged 45+ on ART in Makindye. However, both engaging in running and the use of exercise bike as forms of physical exercise are protective against accelerated ageing among them. Surprisingly, smoking, alcohol consumption and the use of recreational drugs are of no risk to their accelerated ageing. More frequent exercises through aerobics and the purchase of jogging costumes and bicycles are highly recommended.
Low Enrolment in Ugandan Community Health Insurance Schemes Underlying Causes and Policy Implications
(BioMed Central, 2025-06-27) Robert Basaza; Bart Criel; Patrick Van der Stuyft
Background: Despite the promotion of Community Health Insurance (CHI) in Uganda in the second half of the 90's, mainly under the impetus of external aid organisations, overall membership has remained low. Today, some 30,000 persons are enrolled in about a dozen different schemes located in Central and Southern Uganda. Moreover, most of these schemes were created some 10 years ago but since then, only one or two new schemes have been launched. The dynamic of CHI has apparently come to a halt. Methods: A case study evaluation was carried out on two selected CHI schemes: the Ishaka and the Save for Health Uganda (SHU) schemes. The objective of this evaluation was to explore the reasons for the limited success of CHI. The evaluation involved review of the schemes' records, key informant interviews and exit polls with both insured and non-insured patients. Results: Our research points to a series of not mutually exclusive explanations for this underachievement at both the demand and the supply side of health care delivery. On the demand side, the following elements have been identified: lack of basic information on the scheme's design and operation, limited understanding of the principles underlying CHI, limited community involvement and lack of trust in the management of the schemes, and, last but not least, problems in people's ability to pay the insurance premiums. On the supply-side, we have identified the following explanations: limited interest and knowledge of health care providers and managers of CHI, and the absence of a coherent policy framework for the development of CHI. Conclusion: The policy implications of this study refer to the need for the government to provide the necessary legislative, technical and regulative support to CHI development. The main policy challenge however is the need to reconcile the government of Uganda's interest in promoting CHI with the current policy of abolition of user fees in public facilities.
Structures and Available Processes to Support Perinatal Care in District Hospitals of Western Uganda
(Journal of Research & Health, 2024-07-01) Mercy Muwema; Joaniter I Nankabirwa; Dan K. Kaye; Gorrette Nalwadda; Joanita Nangendo; Gloria Odei Obeng- Amoako; Jean Claude Nkurunziza; Wilson Mwanja; Elizabeth N. Ekong; Robert Basaza; Joan N. Kalyango; Grace Edwards
Background: To emphasize the essence of high-quality care in reducing maternal and neonatal mortality and morbidity, the World Health Organization (WHO) developed standards to support planners. This study describes the structures and care processes that were in place to support perinatal care provided to pregnant women at three district hospitals in Bunyoro region, Uganda using the WHO standards as a benchmark. Methods: A cross-sectional study was conducted using pre-tested structured questionnaires and an observation checklist among 61 facility managers and healthcare providers working in perinatal units. The data were collected on structures that focused on staffing, basic equipment, essential medicines and supplies, diagnostic capacity, and basic amenities. In addition, data were collected on the following processes: Supervision of perinatal care, in-service training for perinatal healthcare providers, transition in care, coordination of care, and continuity of care. Descriptive analysis was used for all the data using the STATA software, version 13. Results: Only 5 out of 18 doctors were designated to perinatal units. Each hospital had only one anesthetic officer. Two out of three of the hospitals did not have vital equipment in their postnatal units nor any communication equipment in all their perinatal units. No maternity unit had a designated waiting space for women in labor. The highest bed density for delivery and maternity beds was 6.6 per 1000 pregnant women. Refresher training was only offered once a year. Receiving units were not notified of the referral. Patient care records were paper-based using papers/exercise books as alternative documentation tools. Medications and laboratory or diagnostic findings were the least documented. Conclusion: There is a shortage of critical human resources, equipment, and delivery and maternity beds. There were gaps in the communication of referrals and documentation of pregnant women’s care. The presence of a robust infrastructure, staffing, equipment, and medicines is critical in the provision of quality care to pregnant women.
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.
Trends in Inequality in Maternal and Child Health and Health Care in Uganda: Analysis of the Uganda Demographic and Health Surveys
(BMC Health Services Research, 2022) Alex Ayebazibwe Kakama; Robert Basaza
Background Uganda has made great strides in improving maternal and child health. However, little is known about how this improvement has been distributed across different socioeconomic categories, and how the health inequalities have changed over time. This study analyses data from Demographic and Health Surveys (DHS) conducted in 2006, 2011, and 2016 in Uganda, to assess trends in inequality for a variety of mother and child health and health care indicators. Methods The indicators studied are acknowledged as critical for monitoring and evaluating maternal and child health status. These include infant and child mortality, underweight status, stunting, and prevalence of diarrhea. Antenatal care, skilled birth attendance, delivery in health facilities, contraception prevalence, full immunization coverage, and medical treatment for child diarrhea and Acute Respiratory tract infections (ARI) are all health care indicators. Two metrics of inequity were used: the quintile ratio, which evaluates discrepancies between the wealthiest and poorest quintiles, and the concentration index, which utilizes data from all five quintiles. Results The study found extraordinary, universal improvement in population averages in most of the indices, ranging from the poorest to the wealthiest groups, between rural and urban areas. However, significant socioeconomic and rural-urban disparities persist. Under-five mortality, malnutrition in children (Stunting and Underweight), the prevalence of anaemia, mothers with low Body Mass Index (BMI), and the prevalence of ARI were found to have worsening inequities. Healthcare utilization measures such as skilled birth attendants, facility delivery, contraceptive prevalence rate, child immunization, and Insecticide Treated Mosquito Net (ITN) usage were found to be significantly lowering disparity levels towards a perfect equity stance. Three healthcare utilization indicators, namely medical treatment for diarrhea, medical treatment for ARI, and medical treatment for fever, demonstrated a perfect equitable situation. Conclusion Increased use of health services among the poor and rural populations leads to improved health status and, as a result, the elimination of disparities between the poor and the wealthy, rural and urban people.
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.
What are the emerging features of community health insurance schemes in East Africa?
(Dove Press, 2009-06-16) Robert Basaza; George Pariyo; Bart Criel
Background: The three East African countries of Uganda, Tanzania, and Kenya are characterized by high poverty levels, population growth rates, prevalence of HIV/AIDS, under-funding of the health sector, poor access to quality health care, and small health insurance coverage. Tanzania and Kenya have user-fees whereas Uganda abolished user-fees in public-owned health units. Objective: To provide comparative description of community health insurance (CHI) schemes in three East African countries of Uganda, Tanzania, and Kenya and thereafter provide a basis for future policy research for development of CHI schemes. Methods: An analytical grid of 10 distinctive items pertaining to the nature of CHI schemes was developed so as to have a uniform lens of comparing country situations of CHI. Results and conclusions: The majority of the schemes have been in existence for a relatively short time of less than 10 years and their number remains small. There is need for further research to identify what is the mix and weight of factors that cause people to refrain from joining schemes. Specific issues that could also be addressed in subsequent studies are whether the current schemes provide financial protection, increase access to quality of care and impact on the equity of health services financing and delivery. On the basis of this knowledge, rational policy decisions can be taken. The governments thereafter could consider an option of playing more roles in advocacy, paying for the poorest, and developing an enabling policy and legal framework.
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.
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.