Browsing by Author "Bikaitwoha, Everd Maniple"

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The Challenges of Managing Government-seconded Health Workers in Private Not-for-profit Health Facilities of Kibaale District, Uganda
(Uganda Martyrs University Press, 2008-12) Bikaitwoha, Everd Maniple; Barugahara, Peter; Mugisha, John Francis
Private health care providers are an important component of pluralistic national health systems. In Uganda, the public-private partnership for health (PPPH) has led to the government assisting the private health sector in various ways, in recognition of and support to their work. Apart from financial assistance, the government deploys civil servants to work in private-not-for-profit (PNFP) health facilities. Such government-seconded health workers are recruited, deployed and paid by the government but they work under the management of the PNFP health units. In the rural and remote district of Kibaale in mid-western Uganda, government-seconded health workers form 48% of the key professional staff in PNFP health services. However, government secondment raises a number of important managerial and human resource challenges. PNFP health care managers have some workers over whom they do not have full authority and control. The seconded workers have to serve two authorities and satisfy them equally. This cross-sectional descriptive study aimed at identifying the problems arising from this kind of relationship in a district where PNFP health units are heavily dependent on governmentseconded personnel, and how such problems may be addressed. It was found that there is unequal treatment of seconded and non-seconded staff, with the former receiving better pay, and having more professional management than the latter. However, they felt there was too much workload in PNFP units compared to government and were not comfortable with the PNFP prohibition of private practice. In addition, they felt that they were not trusted by the PNFP managers and that they had limited or no opportunities for career development and further studies. PNFP managers felt they had no control over seconded staff and felt that they have no possibility to participate in the selection of staff to be seconded to their units. As a result, seconded staff were perceived to have no commitment to work in PNFP units, and to be prone to absenteeism, illegal private practice, demand for big financial allowances, abrupt attrition and pilferage of health care supplies. This paper proposes quick enactment of the PPPH policy to define the relationship between the public and the private sectors. It also proposes that the government gives unconditional funding to the PNFP facilities on a contractual basis, and only demands for accountability on agreed outputs. This would facilitate the PNFP managers to recruit their own staff and endeavour to attain the agreed outputs.
Do Ugandan Medical Students Intend to Work in Rural Health Facilities After Training?
(Uganda Martyrs University Press, 2009-12) Bikaitwoha, Everd Maniple; Wandiraa, Geoffrey
There is a persistent shortage of qualified health workers globally, but worse in developing countries, where it is even worse in rural areas than urban and peri-urban areas. Health workers refuse to be deployed in rural areas or migrate to urban areas in search of better physical facilities and to avoid professional isolation, among other reasons. Health workers brought up in urban areas have not experienced rural life and find it difficult to countenance a professional life in rural areas. Several training institutions have engaged in programmes to expose pre-service health workers to rural health work to demystify it and to enable the professionals make an informed choice on practice location after qualification. In this study, the intentions of Ugandan medical students to work in rural health facilities after qualification were sounded out, together with the factors that affect them and their perception of rural areas. The study covered five government medical schools (2 for doctors and 3 for Clinical Officers). Students of all years of study in the different courses were interviewed, as well as key informants in the administration of the schools. At least one half of all the respondents (50% or 167/336) were clear that they did not intend to work in the rural facilities after training, while the other half was divided equally among those who wanted and those who were not sure yet. Whereas the proportion of those intending to work in rural areas rose progressively from the first year of studies, it reached a peak in the pre-final year (fourth year for student doctors and second year for clinical officers) and plummeted in the final year after the students had residential field experience. The majority of the students had a negative perception about working in the rural areas and associated them with lack of physical facilities, social services and communication. Personal demographic characteristics and previous exposure to a rural life did not seem to be related to a choice about work in rural areas. Most of the few students who intended to work in rural areas hoped to stay for not more than three years, before going either for further studies or for self-employment in urban areas. The paper recommends review of the community exposure programmes of the medical schools, with a view to improve support supervision in the field and logistical support for the students during attachment. It also recommends better facilitation of rural health facilities and better incentives and remuneration for rural health workers.
Factors Realated to the Uptake of Natural Family Planning by Clients of Catholic Health Units in Masaka Diocese, Uganda
(Uganda Martyrs University Press, 2008-12) Bikaitwoha, Everd Maniple; Nakiboneka, Catherine
Globally and locally in Uganda, family planning (FP) is promoted to enable individuals and couples to space and limit childbirth. FP promotion is based on demographic and health concerns and basic human rights. Clients can use either artificial family planning (AFP) or natural family planning (NFP) methods but none is 100% effective. Whereas NFP methods are known to be free from side effects, with no continuous costs, and widely accepted by most religions and cultures, most clients use AFP methods despite their many side effects and costs. The Roman Catholic Church (RCC) opposes AFP methods on fundamental grounds such as the definition of the onset of life and the purpose of sexual union. Additional reasons fronted by the church include the potential misuse of AFP methods and the false sense of security they impart to the users. This study set out to find out how health services under the RCC promote the use of NFP methods in an area of heavy RCC presence, and how these efforts translate into uptake of the methods. It shows that despite the recommendation of NFP methods, RCC health units did not have staff trained in promoting and offering NFP methods. There were no budgets, supplies, registers, teaching AIDS, and no records of NFP clients were kept. No space for NFP clinics was provided and there was no arrangement for continuous professional education (CPE) for NFP providers. Basic knowledge about NFP e.g. the role of breastfeeding and periodic abstinence was acquired from friends. Knowledge about NFP methods was insufficient among clients to the services and in some health workers. Most of the respondents, of which 76 %( 154/202) were Catholics had more information about AFP methods and knew where to access them. The study recommends that RCC authorities in Uganda, as the main champions of NFP, need to provide political commitment to NFP, invest more in and reinvigorate the teaching of NFP methods through their structures. In addition, there is need for support supervision on NFP access and use within RCC health facilities.
Medical Litigation in Hospitals in Kampala, Uganda
(International Journal of Public Health Research, 2015-07-20) Gakumba, Eva Kadimba; Katongole, Simon Peter; Bikaitwoha, Everd Maniple
Seeking legal redress for harm sustained while receiving medical care is common in some developed countries but less common in most developing countries. However, unconfirmed reports suggest that litigation is on the increase even in developing countries like Uganda. Litigation influences the behaviour of both health care workers and hospital managers, with significant consequences for patients and the entire health system. Given the dearth of publications on the extent of medical litigation in developing countries, this exploratory study sought to determine the prevalence, trends, determinants and effects of medical litigation on medical practice in hospitals in Kampala. Using a mixed methods approach, ten Kampala hospitals belonging to the government, private not-for-profit (PNFP) and for-profit (PFP) organisations that had been in operation for at least 5 years were purposively studied. Participants included medical directors, officials from courts of judicature, health professional bodies, and officials from health care consumer organisations. The study revealed that medical litigation in Kampala was still minimal but increasing steadily. Surgeons and Obstetricians / Gynecologists were the specialties most at risk of medical litigation. Significant factors responsible for the increase in medical litigation trends were: heavy workload; increased exposure to medical information; and increased awareness on patient rights. Medical litigation has led to improvement in quality of health care, huge financial burden to the health care providers, and suspension or outright withdrawal of health workers from medical practice. Efforts to reduce litigation include continuous professional development, better staff recruitment practices and strict enforcement of standard operating procedures. There is need for dialogue between the patient safety stakeholders, staff training on patient-centred care and training of managers on the implications and processes of medical litigation.
Perceptions of Health Workers and Managers on the Use of Non-Monetary Human Resource Motivation Tools in General Hospitals of Central Uganda
(Open Science, 2015-08-30) Katongole, Simon Peter; Mugisha, John Francis; Anguyo, Robert; Bikaitwoha, Everd Maniple; Wampande, Lillian Nantume
World over, there is a driving force to create a health care workplace that motivates, maintains and obtains the best out of health workers. In order to achieve this, non-monetary tools can be employed by health managers in hospital settings. Therefore, a study was carried out in six Ugandan general hospitals to establish the perceptions of health workers on the use of non-monetary human resource motivation tools and to examine the contribution of these tools to employees’ motivation. A cross-sectional qualitative study was employed. Key informant interviews with three District Health Officers and 15 top hospital managers were conducted. Six focus group discussions, one in each hospital where also conducted with participating health workers derived from professional groups such as medical officers, enrolled/registered midwives and nurses and allied health professionals. Health workers were interviewed on prevailing practice, adequacy, experience, functioning and views on core non-monetary human resource motivation tools such as training, supervision, performance assessments, and management. Critical incidents were nonmonetary human resource motivation tools had influenced the motivation of some health workers were identified. The use of core non-monetary human resource tools such as continuous medical education, communication between health workers, taking part in decisions of the hospital and organizing social functions were well perceived by the respondents. Promotion of health workers, recognizing best performers, supervision, training and workshops were not well perceived. Health workers were mainly: motivated by the good work relationships and they were mainly demotivated by the poor working conditions. There is a need to have urgent attention on factors which seem to affect the effective use of the non-monetary human resource tools. The factors include; improving working conditions and staffing to reduce workload and avail enough resources to the workers to be motivated carry out their work.
Preparedness for Mass Casualities of Road Traffice Crashes in Uganda
(Uganda Martyrs University Press, 2011-04) Bikaitwoha, Everd Maniple; Onyachia, Nathan W; 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.
Utilisation of Community Audio Towers in Health Education for Prevention of Cervical Cancer by Health Workers in Kyotera District, Uganda: A Cross-Sectional Study
(Dove Press, 2021-09-01) Kabanda, Richard; Bikaitwoha, Everd Maniple; Baluku, Joseph Baruch; Kiconco, Arthur
Purpose: Community audio towers (CATs) are a communication resource that can be utilized by public health practitioners to enhance health communication in rural and periurban settings. However, information on availability of this channel of communication for use in health education and promotion remains scanty. We determined the availability of CATs for use in cervical cancer health education among health workers for prevention of cervical cancer in Kyotera District, Uganda. Methods: Using a cross-sectional study design, health workers were randomly selected from health facilities in Kyotera District. Eligible participants were health workers who had worked in the district for at least one year. A pre-tested study questionnaire was self administered. Descriptive statistics were used to determine availability and use of CATs, while factors associated with the use of CATs were determined by logistic regression analysis. Results: Between March and April 2020, 160 health workers were enrolled, and of these, 102 (63.8%) were females and 69 (43.1%) were nurses. Most of them, ie, 143 (89.4%) reported that CATs were within walkable distance from their workplaces; 140 (87.5%) indicated that CATs are conveniently located, and 129 (80.6%) reported that it was easy to secure airtime to sensitise communities on health issues. Only 26 (16.3%) had ever used CATs for cervical cancer health education. Health workers at facilities without a plan that includes CATs as a channel of health communication were less likely to utilise CATs (OR =0.04, 95% CI (0.0043–0.37), p = 0.005) while those who had ever managed a patient with cervical cancer (OR = 16.48, 95% CI (3.4–79.7), p < 0.001) were more likely to utilise CATs. Conclusion: Although CATs were deemed readily available, there was low utilisation for cervical cancer education and promotion of preventive services by health workers. Health facilities need to strategically include CATs in their plans to increase utilisation.