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THE IMPACT OF DECENTRALIZATION ON HEALTH SERVICES IN UGANDA: A LOOK AT FACILITY UTILIZATION, PRESCRIBING, AND AVAILABILITY OF ESSENTIAL DRUGS. Ogwal-Okeng JW, Anokbonggo WW, Obua C,Ross-Degnan D, Aupont O. International Conference on Improving Use of Medicines Chiang Mia, Thailand
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THE IMPACT OF DECENTRALIZATION ON HEALTH SERVICES IN UGANDA: A LOOK AT FACILITY UTILIZATION, PRESCRIBING, AND AVAILABILITY OF ESSENTIAL DRUGS
Ogwal-Okeng JW, Anokbonggo WW, Obua C,Ross-Degnan D, Aupont O.
International Conference on Improving
Use of Medicines
Chiang Mia, Thailand
April 1, 2004
INRUD Uganda and Makerere University
Project supported as part of the Joint Initiative on Improving Use of Medicine under a grant from ARCH
Problem Statement: Uganda started implementing a structural adjustment program, which resulted in the decentralisation of health services to district level, in July 1994. It was intended to improve the quality of health services and pharmaceutical supplies in the hospitals, with resultant increases in the level of utilization of health services.
Objective: To assess the impact of this policy on facility utilization; prescribing patterns for ARI, diarrhoea, and malaria; and on availability of essential drugs in hospitals in Uganda.
Design: Mixed evaluation study design using both qualitative and quantitative methods. With time series analysis of indicators before and after the policy.
Setting and Population: The study was done in two district hospitals in northern Uganda. Patient records in the hospitals were analyzed retrospectively. In-depth interviews were conducted with politicians; open-ended questionnaires and focus group discussions were administered to patients and health workers respectively.
Outcome Measures: Facility utilization was evaluated by average monthly attendance in the outpatient department and pediatric ward admissions. Prescribing indicator outcomes were: average number of drugs prescribed per case; % drugs given by injections; % antibiotics prescribed; % chloroquine tablets for malaria; % chloroquine injections prescribed for malaria; and % anti-diarrheal drugs prescribed for non-infective diarrhoea. Availability was assessed as average percent availability of nine essential drugs and number of drugs whose availability was more than 40 %.
Results: There was a general increase in patient attendance in both hospitals, although the initial increase later declined in Apac district. Drug availability was erratic and not always adequate in both districts. This was much better in Lira district, where funding for drug procurement was more accessible. Prescribing patterns varied, with improvement in some indicators, while other indicators showed no change or even worsened.
Conclusions: The decentralisation policy increased health facility utilization. All stakeholders considered the policy to be good. However, it has so far failed to solve drug shortages, inefficient utilization of resources, and general low morale among hospital staff. Staff should be retrained and better remunerated in order to cope with the implementation of the policy. Local politicians should clearly understand their roles and responsibility under the new policy. Efficient utilization of funds at all levels of the district administrative structures should be ensured.
Study Funding: Applied Research in Child Health (ARCH) through a grant from the United States Agency for International Development (USAID)
To assess the impact of decentralization policy on quality of health care services in Uganda based on levels of facility utilization, prescribing behavior and stock levels of essential drugs
Design and setting
- Analyses of facility utilization records, Phamacy stocks, and prescriptions.
- Key informant interviews and focus group with 351 Stakeholders