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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.
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.
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.
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.
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.
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.
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.
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.
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.
Delays in Diagnosis and Treatment of Pulmonary Tuberculosis in Patients Seeking Care at a Regional Referral Hospital, Uganda: A Cross Sectional Study
(BMC Research Notes, 2019) Winters Muttamba; Samuel Kyobe; Alimah Komuhangi; James Lakony; Esther Buregyeya; Eldad Mabumba; Robert K. Basaza
Objective: A cross-sectional survey involving 134 pulmonary TB patients started on TB treatment at the TB Treatment Unit of the regional referral hospital was conducted to ascertain the prevalence of individual and health facility delays and associated factors. Prolonged health facility delay was taken as delay of more than 1 week and prolonged patient delay as delay of more than 3 weeks. A logistic regression model was done using STATA version 12 to determine the delays. Results: There was a median total delay of 13 weeks and 110 (82.1%) of the respondents had delay of more than 4 weeks. Patient delay was the most frequent and greatest contributor of total delay and exceeded 3 weeks in 95 (71.6%) respondents. At multivariate analysis, factors that influenced delay included poor patient knowledge on TB (adjOR 6.904, 95% CI 1.648–28.921; p = 0.04) and being unemployed (adjOR 3.947, 95% CI 1.382–11.274; p = 0.010) while being female was found protective of delay; adjOR 0.231, 95% CI 0.08–0.67; p = 0.007). Patient delay was the most significant, frequent and greatest contributor to total delay, and factors associated with delay included being unemployed, low knowledge on TB while being female was found protective of delay.
The Handwashing Practices and Awareness Among Children in Primary Schools in Karongi District, Rwanda: What Strategies Can Promote Effective Handwashing Practices?
(Texila International Journal of Public Health, 2024-09-30) Theoneste Nteziryayo; Robert K. Basaza
Child mortality in Africa is a pressing issue, particularly due to diarrhea and respiratory tract infections. These diseases are often transmitted through improper handwashing practices. This research aimed to identify the factors that influence handwashing habits and assess the availability of adequate facilities and water sources in primary schools in the Karongi district. A mixed-method approach was used to collect data from 583 students through structured questionnaires and 120 teachers through semi-structured interviews. Additionally, interviews with parents and community members were conducted to gain broader insights into community hygiene practices and support systems. Quantitative analysis using SPSS showed that promoting handwashing among school children reduces illness and absenteeism. Over two-thirds (67.2%) of students reported receiving effective support from their teachers, and another two-thirds (66.7%) stated that they wash their hands with soap and water. Moreover, close to another two-thirds (64%) of students acknowledged the importance of hygiene in disease prevention, and nearly two-thirds (60.9%) were aware of the health risks associated with poor hygiene. Qualitative findings revealed that while primary schools have sufficient hygiene facilities, there are challenges such as water shortages, inadequate hygiene resources, a limited number of washing stations, and water supply shortages. The study concludes that it is crucial to promote handwashing through educational campaigns to reduce disease transmission and improve the health outcomes of school children in Rwanda. Additionally, it emphasizes the need to address resource challenges in primary schools.
Understanding Client Satisfaction With a Health Insurance Scheme in Nigeria: Factors and Enrollees Experiences
(Health Research Policy and Systems, 2011) Shafiu Mohammed; Mohammad N Sambo; Hengjin Dong
Background: Health insurance schemes have been widely introduced during this last decade in many African countries, which have strived for improvements in health service provision and the promotion of health care utilization. Client satisfaction with health service provision during the implementation of health insurance schemes has often been neglected since numerous activities take place concurrently. The satisfaction of enrollees and its influencing factors have been providing evidence which have assisted in policy and decision making. Our objective is to determine the enrollee’s satisfaction with health service provision under a health insurance scheme and the factors which influence the satisfaction. Methods: This retrospective, cross-sectional survey took place between May and September 2008. Two hundred and eighty (280) enrollees insured for more than one year in Zaria-Nigeria were recruited using two stage sampling. Enrollee’s satisfaction was categorized into more satisfied and less satisfied based on positive responses obtained. Satisfaction, general knowledge and awareness of contribution were each aggregated and assessed as composite measure. Logistic regression analysis was used to analyze factors that influenced the satisfaction of enrollees. Results: A high satisfaction rate with the health insurance scheme was observed (42.1%). Marital status (p < .05), general knowledge (p < .001) and awareness of contributions (p < .05) positively influenced clients’ satisfaction. Length of employment, salary income, hospital visits and duration of enrolment slightly influenced satisfaction. Conclusions: This study highlighted the potential effects of general health insurance knowledge and awareness of contributions by end-users (beneficiaries) of such new program on client satisfaction which have significant importance. The findings provided evidence which have assisted the amendment and re-prioritization of the medium term strategic plan of operations for the scheme. Future planning efforts could consider the client satisfaction and the factors which influenced it regularly
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.
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.
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.
Identifying Key Steps in Developing a One-stop Shop for Health Policy and System Information in a Limited-resource Setting: A Case Study
(Journal of Research and Health, 2022-11-01) Boniface Mutatina; Robert Kanyarutokye Basaza; Nelson Kawulukusi Sewankambo; John Norman Lavis
Background: Limited understanding exists about the development of online one-stop shops for evidence in a limited-resource setting, such as Uganda. This study aimed to provide a comprehensive account of the development process of the online resource for local policy and systems-relevant information in this setting. Methods: We utilized a case study design to address our objective where the case (i.e., unit of analysis) was defined as “the Uganda clearinghouse for health policy and system (UCHPS) the development process”. We collected data from multiple sources, including key informant interviews, participant observations, and archival records to develop a comprehensive account of the case under investigation. Results: We found out that the development of Uganda clearinghouse for health policy and system (UCHPS) followed a seven-step process, characterized by iterations that occurred within and between the steps. The essential components of the process included concept development, prototyping the key structure, engaging with policymakers, researchers, and other stakeholders, mobilizing and indexing the content, disseminating the resource, user-testing, and updating the system. Conclusion: Our study provides key steps for developing a one-stop shop for local evidence to inform health policy and system decisions. Researchers and institutions, especially those in low and middle income countries (LMICs) may apply this step-by-step inventory to develop similar resources. The inventory is based on knowledge translation (KT) evidence and product design principles along with insights drawn from the practical experience of developing an online KT platform in a limited-resource setting.
The Feasibility Analysis of Integrating Community-Based Health Insurance Schemes Into the National Health Insurance Scheme in Uganda
(PloS one, 2024-04-14) Prossy Kiddu Namyalo; Boniface Mutatina; Sarah Byakika; Aliyi Walimbwa; Rose Kato; Robert K. Basaza
Background Uganda has a draft National Health Insurance Bill for the establishment of a National Health Insurance Scheme (NHIS). The proposed health insurance scheme is to pool resources, where the rich will subsidize the treatment of the poor, the healthy will subsidize the treat- ment of the sick, and the young will subsidize the treatment of the elderly. However, there is still a lack of evidence on how the existing community-based health insurance schemes (CBHIS) can fit within the proposed national scheme. Thus, this study aimed at determining the feasibility of integrating the existing community-based health financing schemes into the proposed National Health Insurance Scheme. Methods In this study, we utilized a multiple–case study design involving mixed methods. The cases (i.e., units of analysis) were defined as the operations, functionality, and sustainability of the three typologies of community-based insurance schemes: provider-managed, community-managed, and third party-managed. The study combined various data collection methods, including interviews, survey desk review of documents, observation, and archives. Findings The CBHIS in Uganda are fragmented with limited coverage. Only 28 schemes existed, which covered a total of 155,057 beneficiaries with an average of 5,538 per scheme. The CBHIS existed in 33 out of 146 districts in Uganda. The average contribution per capita was estimated at Uganda Shillings (UGX) 75,215 = equivalent to United States Dollar (USD) 20.3, accounting for 37% of the national total health expenditure per capita UGX 51.00 = at 2016 prices. Membership was open to everyone irrespective of socio-demographic status. The schemes had inadequate capacity for management, strategic planning, and finances and lacked reserves and reinsurance. The CBHIS structures included promoters, the scheme core, and the community grass-root structures. Conclusion The results demonstrate the possibility and provide a pathway to integrating CBHIS into the proposed NHIS. We however recommend implementation in a phased manner including first providing technical assistance to the existing CBHIS at the district level to address the critical capacity gaps. This would be followed by integrating all three elements of CBHIS structures. The last phase would then involve establishing a single fund for both the formal and informal sectors managed at the national level.
Exploring Handwashing Practices and Awareness Among Primary School Children in Karongi District, Rwanda: A Cross-Sectional Study
(Texila International Journal of Public Health, 2024-09-13) Nteziryayo Theoneste; Basaza K. Robert
Child mortality is a major concern in Africa, particularly due to diarrhoea and respiratory tract infections, which are the leading causes. These diseases are often transmitted through poor handwashing practices. This study aimed to examine the factors that influence handwashing practices, as well as the knowledge, awareness, and actual practices of handwashing among primary school students in the Karongi district, Rwanda. A mixed methods approach was utilized, combining quantitative data gathered through an online questionnaire with qualitative data obtained from semi- structured interviews. Interviews were conducted with teachers and students to gain insight into the existing hygiene practices and support systems in place. The sample size consisted of 583 students and 120 teachers. Quantitative data was analyzed using SPSS version 25.0, incorporating Fisher's exact, Chi-square, correlation, and multiple regression tests. Qualitative data was analyzed using NVivo version 14.0. The correlation (r=0.75; p<0.001) and multiple regression analyses demonstrated that knowledge of handwashing practices significantly influenced awareness (r=0.612; p<0.001), the availability of hygiene facilities (r=0.665; p<0.001), and the implementation of hygiene practices. The students and teachers in Karongi possess a certain level of knowledge regarding handwashing techniques. Teachers in all primary schools supported the practice of handwashing. Students were washing their hands with soap and water as a means of reducing the transmission of diseases. However, more emphasis on instilling proper handwashing practices is required. Handwashing campaigns should be utilized to encourage good hygiene practices among children, as the primary schools already have adequate facilities in place.
Experiences of Seeking Antenatal Care and Delivery Among Teenagers in Kibuku District, Uganda
(Journal Research & Health, 2022-07-01) Rebecca Namusana; Josephine M. Namyalo; Emmanuel D. Otieno; Robert K. Basaza
Background: Uganda is ranked 14 out of 54 countries in Africa with the highest level of teenage pregnancy. The teenage pregnancy rate in Kibuku District in 2016 was 35.8%, high above the average rate in Uganda (25%) and also above rural areas in Uganda (27%). Unfortunately, there is limited information on the experiences of seeking antenatal care and delivery among teenagers. This paper explored teenagers’ experiences seeking services at health facilities in the Kibuku district, Eastern Uganda. Methods: This study used a phenomenological design. Data were collected using in-depth interviews with 27 teenagers aged 14-19 years seeking antenatal care (ANC) or those who had delivered. The teenagers were purposively selected to participate in the study. Data collected was thematically and inductively analyzed through coding. Results: The study showed that most teenage mothers knew the importance of seeking ANC and delivery from a health facility. Unfortunately, few sought services early due to some experiences, including financial constraints, support from their caregivers (husbands and parents), medication, and health education. The teenagers were motivated to attend ANC and were treated well by health workers. However, most teenagers did not have the decision-making power to seek care. Conclusion: Teenage mothers knew the importance of seeking ANC and delivery at health facilities. Their experiences with the health facilities also contributed to the health-seeking behavior of the teenagers, including the comfort received by the girls at the facility, the medication administered, how they were treated by the health workers and the availability of utilities. Health and social workers could consider sensitizing teenagers and their caregivers about the delicate nature of their health when pregnant to make personal decisions.

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