Browsing by Author "Bakaitwoha Everd Maniple"

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Care for people living with disabilities in the West Nile region of Uganda:
(Uganda Martyrs University Press, 2009-12-01) Waelkens Maria-Pia; Bakaitwoha Everd Maniple; Nakiwala Stella Regina
Disability is a common occurrence in many countries and a subject of much discussion and lobby. People with disability (PWD) are frequently segregated in society and by-passed for many opportunities. Stigma hinders their potential contribution to society. Doctors with Africa CUAMM, an Italian NGO, started a project to improve the life of PWD in the West Nile region in northwestern Uganda in 2003. An orthopaedic workshop, a physiotherapy unit and a community-based rehabilitation programme were set up as part of the project. This ex-post evaluation found that the project made an important contribution to the life of the PWD through its activities, which were handed over to the local referral hospital for continuation after three years. The services have been maintained and their utilisation has been expanded through a network of outreach clinics. Community-based rehabilitation (CBR) workers mobilise the community for disability assessment and supplement the output of qualified health workers in service delivery. However, the quality of care during clinics is still poor on account of large numbers. In the face of the departure of the international NGO, a new local NGO has been formed by stakeholders to take over some functions previously done by the international NGO, such as advocacy and resource mobilisation. This is an example of a local resource facilitating the sustainability of good initiatives. Among other things, this paper recommends that the CBR programme be strengthened and expanded to cover the entire region. It also recommends that outreach clinics should be planned in a better way in order to reduce the workload of the health workers and improve the quality of care. It also recommends that the local NGO should be supported to fit into the shoes of the more experienced but exiting international NGO.
Funding mechanisms for the 'private-not-for-profit' health training institutions in Uganda.
(Uganda Martyrs University Press, 2007-04-01) Mugisha F. John; Bakaitwoha Everd Maniple; Pemba Senga K.
The Health Sector Strategic Plan (HSSP) aims to ensure access to basic health care by the Ugandan population through the delivery of the National Minimum Health Care Package (NMHCP). This requires availability of well-trained health professionals. This study demonstrates that the PrivateNot-For-Profit (PNFP) Health Training Institutions - the majority in Uganda - have remained grossly under-funded, which poses a threat to achievement of the HSSP. They are faced with decreasing income from fees, dwindling donor support and over-dependence on government grants which are both uncertain and erratic. Consequently, vital activities for students' training such as field trips, teaching and reading materials are left unsatisfied as a copying mechanism, but not without negative implications for quality. It is recommended that government increases and guarantees its support to these Health Training Institutions as a way of maintaining quality of health worker training. At the same time, the training institutions need to diversify their funding options to include designing short tailor-made courses, mobilizing alumni contributions, research and consultancies, self-help projects like farming, canteens and stationeries as well as fund-raising activities as a way of bridging their funding gap. This should be coupled with more efficiency mechanisms and prudent management to avoid wastage of the already scarce financial resources.
Is it (not) high time to introduce performance-based pay in Uganda’s health system?
(Uganda Martyrs University Press, 2008-12-01) Bakaitwoha Everd Maniple
Lifetime experience and management of cases of gender-based violence in the health facilities of Kabarole district, Uganda
(Uganda Martyrs University Press, 2008-12-01) Tumwebaze Margaret; Bakaitwoha Everd Maniple; McMorrow Shannon
Gender-based violence (GBV) is a common problem in many countries, leading to high levels of mortality and morbidity, especially of women. In the health sector, GBV presents in a cryptic manner due to fear by the victims, poor records, culture, inadequate staffing and inadequate equipment. In developing countries, there is also a lack of policies, standards and guidelines for case management. As a result, GBV cases are never recognized and are poorly managed. This study set out to assess the management of GBV victims in health facilities of Kabarole District, western Uganda. It aimed at profiling the common forms of GBV, the lifetime experience of GBV by ordinary residents, the accessibility of health services to GBV victims, the health services rendered to them and to analyse inter-sectoral collaboration on GBV issues. A descriptive cross-sectional study involving 400 respondents, 40 key informants and 2 FGDs was done in May and June 2006. Over 96% of the respondents had ever experienced a form of GBV and women were more likely to have experienced it than men. Most were likely to have experienced physical violence. Female respondents were more likely to have abused their victims verbally while the males were more likely to have abused them physically. Most cases of GBV were domestic and were never reported to any authorities or to the health system unless they had led to severe physical injury. This was due to cultural restrictions on discussing domestic matters publicly. GBV survivors also often lacked funds for transport and processing the cases either with the health services, local authorities or police. They reported long waiting times at health facilities, absence of staff, lack of privacy and lack of medicines as the common problems they faced at health facilities. The range of health care services provided to GBV survivors was very narrow and mostly on request by the police. Apart from being insufficient and absent, health workers were not trained in screening for GBV, management of cases and conducting forensic investigations. They did not probe actively for possible history or evidence of GBV and the data were never disaggregated within the HMIS. Intersectoral collaboration on GBV was limited to preparing police dossiers and court testimony. The paper recommends the formulation of a national policy on GBV, and the setting up of standards and guidelines for case management in the health sector. It also recommends adequate equipment of district level facilities for sufficient forensic investigations as well as training of health workers in case management including counseling. It recommends institutionalization of GBV data collection through revision of the HMIS and Continuing Medical Education. Finally, it recommends wider inter-sectoral collaboration in order to enhance prevention of GBV at community level
Making the transition to workload-based staffing:
(BioMed Central, 2015) Namaganda Grace; Oketcho Vincent; Bakaitwoha Everd Maniple; Viadro Claire
Background: Uganda’s health workforce is characterized by shortages and inequitable distribution of qualified health workers. To ascertain staffing levels, Uganda uses fixed government-approved norms determined by facility type. This approach cannot distinguish between facilities of the same type that have different staffing needs. The Workload Indicators of Staffing Need (WISN) method uses workload to determine number and type of staff required in a given facility. The national WISN assessment sought to demonstrate the limitations of the existing norms and generate evidence to influence health unit staffing and staff deployment for efficient utilization of available scarce human resources. Methods: A national WISN assessment (September 2012) used purposive sampling to select 136 public health facilities in 33/112 districts. The study examined staffing requirements for five cadres (nursing assistants, nurses, midwives, clinical officers, doctors) at health centres II (n= 59), III (n= 53) and IV (n= 13) and hospitals (n= 11). Using health management information system workload data (1 July 2010 – 30 June 2011), the study compared current and required staff, assessed workload pressure and evaluated the adequacy of the existing staffing norms. Results: By the WISN method, all three types of health centres had fewer nurses (42 – 70%) and midwives (53 – 67%) than required and consequently exhibited high workload pressure (30 –58%) for those cadres. Health centres IV and hospitals lacked doctors (39 – 42%) but were adequately staffed with clinical officers. All facilities displayed overstaffing of nursing assistants. For all cadres at health centres III and IV other than nursing assistants, the fixed norms or existing staffing or both fell short of the WISN staffing requirements, with, for example, only half as many nurses and midwives as required. Conclusions: The WISN results demonstrate the inadequacies of existing staffing norms, particularly for health centres III and IV. The results provide an evidence base to reshape policy, adopt workload-based norms, review scopes of practice and target human resource investments. In the near term, the government could redistribute existing health workers to improve staffing equity in line with the WISN results. Longer term revision of staffing norms and investments to effectively reflect actual workloads and ensure provision of quality services at all levels is needed.
Overcoming barriers to anti-epileptic treatment:
(Uganda Martyrs University Press, 2008-04-01) Odaga John; Cicciò Luigi; Bakaitwoha Everd Maniple
Epilepsy, like many other mental illnesses, is more prevalent than is commonly acknowledged. Moreover, its social and economic burden is excessive for the individual, family, health system and country at large. People with epilepsy have low quality of life and productivity. They and their families are stigmatized and discriminated against. Doctors with Africa - CUAMM, has operated a project for epilepsy treatment together with the local health authorities in Nebbi and Arua districts since 2005, aimed at increasing access to free, effective anti-epileptic medicines. Despite the availability of the medicines, the attendance of many enrolled patients has been erratic. This study was done to document the level of adherence to treatment, the reasons for the observed healthseeking pattern and to assess the feasibility of sustainability of enhanced epilepsy treatment services once the project ended. Retrospective analysis of records of all patients registered in 2004 and 2005 was done in order to determine the level and pattern of adherence. A cross-sectional survey of 93 patients, selected according to the documented patterns of clinic attendance, was done to investigate the reasons for the observed pattern of healthcare use. Assessment of feasibility of sustainability was done by interviewing key informants and reviewing records of expenditures on anti-epileptic medicines for 2005. Conducted in 2006, the study shows that about 84.5% of the enrolled patients missed at least one appointment over the two-year period of follow-up, with about one third missing all the clinics since enrolment. A typical patient missed about 60% of all the appointments. The overall attendance level at any given time was at a low 40% (30% for those registered in 2005 and 50% for those registered in 2004). There was wide variation in the magnitude and frequency of defaulting at the different sites. Younger and older patients defaulted more often than the middle-aged groups, just as female patients defaulted more frequently than the male counterparts. The reasons for the poor compliance were multiple, patient-specific and often acting simultaneously. The most critical and cross-cutting included distance from the health facility, family support, persistent health education and individual patient/family counseling. The mobilisers (often epilepsy patients themselves) were pivotal in patient/family education and counseling as well as reminding patients about clinic days. The most important adherence-promoting health systems factors were the regular availability of effective medicines and the vertical nature of the delivery system. There were several constraints working against sustainability of enhanced epilepsy care, including technical competence of the health workers, regulatory limitations that forbid the use of some anti-epileptic medicines at some levels of health care, negative staff attitude and high investment levels in ensuring constant availability of anti-epileptic medicines.
Preparedness for mass casualties of road traffic crashes in Uganda:
(Uganda Martyrs University Press, 2011-04-01) Onyachi Nathan W.; Bakaitwoha Everd Maniple; Santini Stefano
In Uganda, increase in human and vehicular populations against a non-expanding road infrastructure, breakdown in enforcement of traffic regulations and poor vehicle quality contribute to the high rate of casualties from road traffic crashes on highways, with over 2000 deaths per year. Highway hospitals should be the vanguard of preparedness to manage mass surgical casualties, to minimize road crash mortality. Objectives: To determine the capacity of Uganda’s highway hospitals to manage mass surgical casualties. Methods: A descriptive, cross-sectional study of emergency surgical services of ten key highway general hospitals. Results: The hospitals had adequate capacity to manage uncomplicated solitary cases of injury. However, they had severe shortage of essential surgical equipment (9.6% of expected). Staffing was poor (64.3% of the recommended) and the staff lacked the life-saving surgical skills needed in a frontline hospital. There was perennial shortage of essential supplies e.g. blood, surgical gloves, intravenous fluids, oxygen and medicines. There was inadequate space for emergency surgery and only few staff members reside within easy reach for quick mobilization. Overall surge capacity was rated at below 50% of what is required. Conclusion: Ugandan highway hospitals lack the technical and infrastructural capacity to handle mass casualties resulting from road traffic crashes. Surge capacity is below 50% of that required to manage mass casualties. Recommendations: The key recommendations of this paper are: re-organisation of the outpatient departments to cater for mass emergency surgical cases, deployment of qualified surgeons in highway hospitals, training of hospital staff in life-saving surgical skills, targeted supervision of highway hospitals, training of managers in disaster preparedness, and improved funding for highway hospitals.
The status OF clinical diagnostic imaging services in Uganda’s regional referral hospitals.
(Uganda Martyrs University Press, 2011-04-01) Onziga Hillary; Bakaitwoha Everd Maniple; Bwete Vincent
Background: Clinical imaging is an essential component of health care which supports and improves the effectiveness of clinical decision-making. Quality care saves lives and resources of both the patient and the health system. However, many developing countries have neglected diagnostics, especially clinical imaging. Non-use of or poor imaging services lead to wrong diagnosis and treatment, unnecessary health expenditures, and poor health outcomes. Regional Referral Hospitals should have good diagnostic imaging services to provide expert care and bridge the continuum of care by stemming the flow of uncomplicated cases from general hospitals to National Referral Hospitals. Aim: To determine the situation of diagnostic imaging services at regional referral hospitals in Uganda. Methods: A descriptive cross-sectional survey of all the nine Regional Referral Hospitals of Uganda was done in 2007. Environmental inspection of the imaging units, process observation and exit interviews with 156 patients present on the day of the visit were done to assess their satisfaction with the imaging services. Staff were also interviewed. However, quality validation of the imaging outputs was not done. Selected health facilities in the capital Kampala were visited to obtain data on patients referred from upcountry. Five-year hospital records were reviewed for outputs. Results: The premises were of poor quality and staff and patients were not safe from radiation exposure. No radiosurveillance measures were operational. The output of imaging services was generally very low, (mean: 16 procedures per day, range: 6 - 22) due to lack of consumable inputs. Only 37% (range: 14 – 64) of approved staff positions were filled. Nurses were insufficient and some cadres lacked altogether. Stock-outs of key consumable inputs were prolonged (ultrasound gel: 90 days) and patients were required to buy their own. Many patients were referred to private services but not recorded. Central level supervision by the Ministry of Health was lacking. Conclusion and recommendation: The quality of imaging services was poor, and could be improved through higher prioritization of imaging services in hospital planning, better financing, better support supervision and establishment of an active radio surveillance mechanism.