Browsing by Author "Robert K Basaza"

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Barriers to Access and Utilization of Health Services Among Marginalized Communities in Sub-Saharan African Countries: Scoping Review
(International Journal of Health, Medicine and Nursing Practice, 2024-05-14) Theoneste Nteziryayo; Robert K Basaza; Humphrey C Karamagi; Prossy K Namyalo
Purpose: This scoping review aimed to investigate the barriers encountered by marginalized communities in sub-Saharan African countries when accessing and utilizing healthcare services. Methodology: The scoping review was evaluated through online databases like the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and SCOPUS review according to the barriers to accessing and utilizing health services among marginalized communities in sub- Saharan African countries. The scoping review identifies the articles from the topic through the online databases using the including and excluding criteria. Findings: The findings identified the barriers to healthcare access, lack of communication and language, and not sharing the proper health details with the healthcare professional. The findings also demonstrated the implications and consequences such as health disparities, economic burden, social and human rights implications, loss of productivity and development, public health implications, and reinforcing social exclusion. Unique contribution to theory, practice and policy: This scoping review illuminates the intricate nexus of socio-economic factors, cultural dynamics, and human rights awareness as barriers to healthcare access in sub-Saharan Africa. The findings offer actionable insights for healthcare practitioners to customize services for marginalized communities, addressing communication gaps and information-sharing reluctance. Moreover, policymakers can utilize these insights to advocate evidence-based policies aimed at promoting equitable healthcare access and enhancing health literacy. Thus, this research serves as a vital conduit between theoretical understanding, practical application, and policy formulation, facilitating the advancement of inclusive and equitable healthcare delivery in the region.
Economic Analysis of a New Four-Panel Rapid Screening Test in Antenatal Care in Kenya, Rwanda, and Uganda
(BMC Health Services Research, 2023) Donald S Shepard; Yara A Halasa-Rappel; Katharine R Rowlands; Maria Kulchyckyj; Robert K Basaza; Emmanuel D Otieno; Boniface Mutatina; Simon Kariuki; Sabine Musange
Background We performed an economic analysis of a new technology used in antenatal care (ANC) clinics, the ANC panel. Introduced in 2019–2020 in five Rwandan districts, the ANC panel screens for four infections [hepatitis B virus (HBV), human immunodeficiency virus (HIV), malaria, and syphilis] using blood from a single fingerstick. It increases the scope and sensitivity of screening over conventional testing. Methods We developed and applied an Excel-based economic and epidemiologic model to perform cost-effectiveness and cost-benefit analyses of this technology in Kenya, Rwanda, and Uganda. Costs include the ANC panel itself, its administration, and follow-up treatment. Effectiveness models predicted impacts on maternal and infant mortality and other outcomes. Key parameters are the baseline prevalence of each infection and the effectiveness of early treatment using observations from the Rwanda pilot, national and international literature, and expert opinion. For each parameter, we found the best estimate (with 95% confidence bound). Results The ANC panel averted 92 (69–115) disability-adjusted life years (DALYs) per 1,000 pregnant women in ANC in Kenya, 54 (52–57) in Rwanda, and 258 (156–360) in Uganda. Net healthcare costs per woman ranged from $0.53 ($0.02-$4.21) in Kenya, $1.77 ($1.23-$5.60) in Rwanda, and negative $5.01 (-$6.45 to $0.48) in Uganda. Incremental cost-effectiveness ratios (ICERs) in dollars per DALY averted were $5.76 (-$3.50-$11.13) in Kenya, $32.62 ($17.54-$46.70) in Rwanda, and negative $19.40 (-$24.18 to -$15.42) in Uganda. Benefit-cost ratios were $17.48 ($15.90-$23.71) in Kenya, $6.20 ($5.91-$6.45) in Rwanda, and $25.36 ($16.88-$33.14) in Uganda. All results appear very favorable and cost-saving in Uganda. Conclusion Though subject to uncertainty, even our lowest estimates were still favorable. By combining field data and literature, the ANC model could be applied to other countries.
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.