Over the past fourteen years considerable effort has been made to restore the functional capacity of the health sector, reactivate disease control programmes and re-orient services to Primary Health Care in Uganda. Ensuring that the resources for health fairly reach those with greatest need and that all have fair opportunities for health is a priority and not a matter for the Ministry of Health alone, but for all sectors whose activities affect health, and for all sections of society. As a part of this there is a body of work taking place in Uganda in government, academic and civil society institutions to explore, understand and propose options for reducing inequalities in health in Uganda. This abstract book presents the papers from a national meeting that aimed to assess the progress of equity in health in Uganda, review gaps and needs in the Ugandan health sector, to feed into and draw from experience in East and Southern Africa.
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In this study, authors aimed to identify the impact of the migration of human resources for health on health services in Kenya. The World Health Organization (WHO) 2004 framework on health systems performance was used. The study concentrated on impacts on resource generation, stewardship and service provision and was limited to doctors and nurses. Despite data limitations, the study shows a general trend in migration both locally, from rural to urban areas and internationally, from Kenya to developed countries, with a high emigration rate of 51% for doctors and 71% of respondents indicating an intention to emigrate. From data collected, authors made a rough estimate of inward remittances of about US$90 million annually for nurses and doctors which, however, are not available to the health system and may not match outflows from the health system. In training doctors (schooling and university) alone, about US$95 million invested was lost in Kenya due to migration. Even if remittances were to be accounted for, there still appears to be a net outflow of capital from the country and its health system due to migration. This loss has negative impacts on workloads, especially at peripheral facilities and in some rural districts, which may impact on health service provision and on the referral chain. Increased workloads caused by understaffing result in stress, burn out and demotivation. These become push factors that lead remaining health workers to leave. There was some improvement in workloads in 2005/6 despite increases in service uptake, suggesting that there has been some policy response to the staff crisis in those facilities surveyed.
This study is a first attempt at gathering evidence on the effects of effects of user fee removal on aspects of utilisation and quality of services. The study was based on data collected from a sample of 23 districts in Zambia. The data included total utilisation, attendance levels at health centre outpatient and inpatient maternal and child health facilities, levels of respiratory infections, skin infections, diarrhoea and supervised deliveries, and the availability of drugs. Utilisation data is categorised by age (under-five years of age and over five years) and according to rural or urban districts. There was a substantial increase in total utilisation of public health services (50% increase in rural populations over 5) and an increase in drug consumption. Districts with a greater proportion of poor people recorded greater increases in utilisation of their facilities. Drug consumption in rural districts was estimated to have increased by about 40%. Staff workloads (calculated as the staff-to-patient ratio per day) in rural districts also showed a slight increase after user fees were removed. Based on patients' perceptions, there was no evidence of deterioration in the quality of care since user fees were removed. However, inadequate numbers of skilled health workers presents a major human resources threat to improving access by all. With sustained budget support from government to the DHMTs, the health system can continue to achieve its desired outcomes without relying on user fees.
To promote policies for equity in health HEPS-Uganda, Makerere University Institute of Public Health with EQUINET organised a National Meeting on equity in health in Uganda in March 2008. The meeting reviewed the body of work taking place in Uganda within government, academic and civil society institutions to explore, understand and propose options for reducing inequalities in health in Uganda. The meeting provided an opportunity to exchange evidence, strengthen networking in Uganda, and feed experience into regional networking. The report outlines the papers nd the deliberations. The meeting set up a task force that would take the work forward within key areas of focus, including fair financing; trade and health; health rights and governance and protection of vulnerable groups. HEPS and Makarere University Institute of Public Health are co-ordinating the task force. It was proposed that a follow up national meeting be held in a year to review issues and work.
The manual is intended for use by researchers in preparing papers, in writer’s training workshops; and will be updated in later editions with additional areas of writing skills. This edition of the manual is a guide to producing scientific reports, peer-reviewed articles, EQUINET policy and discussion papers, briefs and reports. It is intended for those involved in EQUINET and related research programmes to prepare papers for publication in reports, papers and in peer-reviewed, scientific journals; to communicate work on health equity; to understand and work with peer review processes; and to improve writing skills generally, including for meeting reports.
This work was implemented as part of a multi-country programme exploring different dimensions of participatory approaches to people centred health systems in east and southern Africa. The process included participatory workshops with twenty-four health workers to increase their understanding of Community Health Committees (CHCs) and to support the CHCs more effectively in future. Three-day Participatory Reflection and Action (PRA) workshops with representatives from Community Health Committees and key stakeholders, and provided an opportunity for health workers to discuss the roles and mapping of neighbourhoods surrounding the health facilities provided an important opportunity for exploring the similarities and differences in the challenges and resources available to the local communities. The post-test survey showed that the community became aware of the important role and function that committees play but were less satisfied with the functioning of the CHCs based on new understanding from the PRA work, while health workers developed more awareness of the CHCs, their potential and limitations. This was agreed to be the start of a process. While PRA supports communities to know and artculate their needs and actions for these, more needs to be done to ensure sustainability of the process.
The study reviewed existing literature, and held focus group discussions and interviews with key informants to examine the contribution of the AIDS levy in Zimbabwe to national health financing. Two provinces were randomly sampled for the in-depth assessment of spending on AIDS levy. The study revealed that the contribution of the AIDS levy has so far been relatively low and undermined by inflation, with inequities in the allocation of funds by province in relation to HIV prevalence. The provincial and district levels, where most patient care takes place, are severely under-funded. If inflation is controlled for, the study concludes that the AIDS levy is a noble idea but that improvements are needed in the allocation of resources.
This participatory action research project aimed to explore and strengthen the community’s capacity to recognise and advocate for their mental health needs, to increase the awareness of mental health problems among the community and to increase collaboration between the mental health workers from clinic and hospital level and the community in the management of mental health problems in the community. Both health workers and community identified exclusion, isolation and poor control over life, associated with risks and a poor physical state, as features of mental ill health. The Kariobangi community was felt to experience high levels of mental ill health, with poverty a major contributing factor. The major mental disorders identified were depression, stress, poverty, lack of awareness, drugs/substance abuse, lack of essential services (mental health services), mental retardation and epilepsy. The intervention is still at an early stage, but the evidence suggests that the PRA approach has strengthened community roles and interaction with health workers in improving mental health care in an underserved community.
We used participatory approaches to facilitate a programme of work aimed at: * Improving communication and understanding between HIV positive clients and the HIV clinic personnel in HIV clinics; Raising HIV positive clients’ voices and participation in improving the HIV clinic services in the division; Promoting networking to overcome isolation, increasing exchange and co-operation through conducting; Participatory approaches, while challenging and time intensive, were perceived by health workers, clients and the facilitators to be a powerful means to enhancing communication, overcoming power imbalances that are barriers to good health or effective use of services and to encouraging the sustainable, “bottom up” community involvement on health visioned in Kenya health policy documents. Real changes were made to make the services more client-friendly, including installed suggestion box, re-streamlined queuing and filling system, taking of vital signs, interpreter involvement, and ordering of bulk drug supply, while clients formed a network that would sustain the communication and reduce social isolation of PLWHIV.
This poster presentation at the Global Health Worker Alliance Conference, March 2008, is based on a study that aimed to determine and assess the impacts of incentives instituted by the Zimbabwe government and non-government sector to retain Critical Health Professionals. It found that the tendency of health professionals to migrate has increased, even among low levels of staff and the macro-economic environment is the main driver of megration. Sustaining the retention incentives in this environment seems unattainable and bonding is unpopular and further increases migration.