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Uganda: Community Perceptions of Quality Healthcare
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The Monitor (Kampala)
14 May 2008
Posted to the web 14 May 2008
Kakaire A. Kirunda
Kampala
Ever wondered what quality means regarding the services provided by the public and some of the privately owned health facilities in this country?
"If a hospital is good, it means that if a patient needs a drip, it's available. The same goes for blood, x-ray and scan services. They should have qualified doctors for diseases like diabetes, ulcers, which are a problem," says a resident of Iganga.
Many look at the infrastructure of hospitals and availability of qualified health workers as some of the indicators of quality healthcare. Another chips in, "The first treatment when I go to the hospital is to find a medical worker who will attend to me in a good way knowing that I am sick and treating me like a human being." And for a group of women in a focus group discussion, "We look at the infrastructure, availability of water, cleanliness of the whole premises i.e. wards, offices, kitchens, compounds etc, availability of qualified staff, convenience places like latrines and bathrooms."
Those were the voices of some of the participants in a formative research for an ongoing broader study that is exploring ways making future health systems work for the poor. The future health systems study is being conducted in five countries including Uganda where the Makerere University School of Public Health is the institution carrying out the research studies.
As aforementioned, the formative research shows several factors mentioned by communities as affecting the quality of services delivered by health facilities. "According to the communities, these were: inadequate numbers of health staff both technical and support staff, shortage of essential drugs, and poor attitude of the health workers, high health costs, long distances and mismanagement of health units," the findings read in part.
The responses of the key informants - savvy to the operations of the healthcare system - were not any different as they mentioned a drastic decline in the quality of services provided by public facilities over the years. "They attributed this to lack of qualified staff, rude health workers, inadequate health budgets, inadequate health staff, lack of essential medicines, corruption and broken down infrastructure," reported the researchers. Discussing the preliminary findings of the study carried out in Iganga and Bushenyi, the researchers led by Dr George Pariyo, argued that the quality of services offered by public and selected private facilities has influenced the utilisation of health facilities and health seeking behaviour of the people.
"The poor sought care from public facilities while the non poor or rich went to private facilities irrespective of cost since they were considered to offer better quality services," they wrote. "Poorer households were more likely to use shops, government dispensaries and herbs, while the least poor households used private clinics."
Further interpreting the findings, the researchers observed that the current situation indicates that the vulnerable are likely to be exposed to catastrophic expenditures and to be pushed into the medical poverty trap. The researchers concluded that healthcare is a major concern but the government budget and financial support to health facilities is still inadequate.
"This has resulted in the provision of services that are largely perceived by the community to be poor quality as evidenced by the poor distribution of health facilities, inadequacy of health workers, negative attitude of health workers, cost and inequity among users," they wrote further, arguing that it is on these, efforts to improve the quality of services should focus.
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Following the formative research, the study that's runs through the end of 2009 is now headed for possible key interventions.
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