Factors Affecting the Provision of Medico-Legal Services by Health Facilities of Lango Sub-Region.
Sabiiti, Fanuel Abwoli
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SABIITI FANUEL ABWOLI (2012-M191-10022) Factors Affecting the Provision of Medico-Legal Services by Health Facilities of Lango Sub-Region Introduction: Medico-Legal Services (MLS) are vital health services worldwide, developed to improve the collection of medico-legal evidence and provide better care to victims/survivors. These services document and collect available evidence for corroboration in courts of law. There are factors that may affect their provision, which may vary from country to country, and even from region to region. The Lango sub-region was deeply affected by the LRA war and violence is known to be high. At the same time, the main highways to the northern region and beyond pass through Lango sub-region (Kampala-Gulu-Juba, Soroti-Lira-Juba, and Lira-Kitgum-Juba). With poor regulation and enforcement of driving standards and the Highway Code, the region is very prone to road traffic accident injuries. Other factors include land disputes due to displacement during the war that eventually results into acts of violence. Unemployment and excessive consumption of alcohol (Lira-Lira) are predisposing factors to violence. In view of the above, it prompted the need for a study to provide some data on which informed decisions can be made for appropriate planning. Among medico-legal cases, sexual violence has received more attention in the study. Objectives: the objectives of the study were: (i) to identify factors affecting the provision of MLS, (ii) to assess the level of knowledge, attitude and practices of health workers with regard to medico-legal issues and, (iii) to establish the most common medico-legal cases in Lango sub-region. Methods: this study was of a descriptive cross-sectional design, and employed both qualitative and quantitative data collection methods. The study sample consisted of 5 health facilities (one regional referral hospital, two general hospitals and two HCIVs) purposively selected. Self-administered questionnaires for key informants (DHOs, Hospital directors/Medical superintendents, DPCs, OC Stations) and respondents (Health workers and Police officers) were used. Observations of examination rooms at places of work, review of relevant records were conducted and check lists used. Results/Findings: the major findings are that most of the health facilities studied lacked some equipment for proper investigations and experienced occasional stock outs of some reagents. All health facilities did not have special rooms for examining victims of sexual violence. The hospitals are having inadequate numbers of medical doctors. The region has never had a Police xvi surgeon. Health workers have limited knowledge on MLS. Duty rosters for MLS do not exist in the facilities. MLS records are not electronically handled. Other findings included late reporting of survivors and interference during investigations. Over a period of 5 years, the most prevalent medico-legal cases in 32 the studied facilities were Road Traffic Accidents: 6681 (46.9%), Assault: 3928 (27.10%) followed by Defilement: 2574 (17.76%). Lira Regional Referral Hospital alone recorded/registered 6,421cases of Road Traffic Accidents and 1,309 cases of assault and battery in five years. The regional referral hospital’s staffing status for medical doctors was at 47.8 %( out of 4 senior consultants only 1 was available, out of 12 consultants supposed to be at the facility only one was available , as for medical officers only 6 were available out of 10 and as for clinical officers they were 14 available out of 20. Conclusions: the study revealed that there are a number of factors affecting the provision of MLS, consequently compromising the quality of service. These factors range from inadequate human resources, infrastructure design, insufficient transport and poor records management. Recommendations: in view of the above findings it is, therefore, recommended that the various district health authorities in the region, together with their local governments recruit and retain medical doctors. As for hospitals, improvising special examination rooms can be worked out with the districts works department. At policy level, the Department of Clinical Services consider setting up training programmes on MLS for health workers already in service and those in the training institutions. The directorate of training in the Police should consider recruiting more police surgeons. Key Words: Factors, Affecting, Provision, Medico-Legal Services, Health Facilities, Lango Sub-Region