Browsing by Author "Corrado Bruno"

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Competing Demands and Limited Resources in the Context of War, Poverty and Disease: the Case of Lacor Hospital
(Uganda Martyrs University, Department of Health Sciences, 2003) Accorsi Sandro; Corrado Bruno; Massimo Fabiani; Iriso Robert; Nattabi Barbara; Ayella Odong Emintone; Ogwang Martin; Onek Paul Awil; Bongomin Pido; Declich Silvia
Difficult choices have to be made among competing demands for health care in the context of severely limited resources and persistent humanitarian crisis prevailing in Northern Uganda. In particular, the challenge of a burden of disease from largely preventable and treatable conditions, the spread of emerging or re-emerging infections, the appearance of new, previously unknown, diseases (such as Ebola), and the heavy burden of poverty and war on health, make it imperative for getting information for identifying priorities and for decision making. However, major information gaps exist, and the little data available has been provided from scattered surveys and from incomplete reporting systems. In this context, readily available information collected using standardized procedures, such as data from hospital discharge records, becomes extremely important, in that these data can provide useful indications on the health situation at a low cost, in a long-term, sustainable way. This study is based on 155,205 medical records of inpatients admitted to the Lacor Hospital during the period 1992-2002, and its objective is to describe the health profile of the population of Northern Uganda, in order to estimate the impact of war, poverty, and social disruption in terms of morbidity and mortality. It analyses also the performance of Lacor Hospital in coping with this emergency situation, exploring pathways and mechanisms that link disease patterns, hospital performance, quality of care, and health outcomes, therefore providing an example of the thinking process leading from information to decision to action.
Costing Health Services in Lacor Hospital
(Uganda Martyrs University, Department of Health Sciences, 2003-12) Murru Maurizio; Corrado Bruno; Odaga John; Ahairwe Denis; Akulu Ernesta; Bavcar Alessandro; Bonane Emmanuel; Kirunda David; Mwesezi Henry; Nagujja Angela; Ndindayino Kalire
Health institutions all over the world are troubled by the intractable problems of shrinking resources and increasing demands for good quality services. Private-Not-For-Profit (PNFP) health units face even more serious problems. The financial support coming to them from donations has significantly decreased in the last 20 years. Raising user fees is not a viable option as fees high in relation with families’ income exclude the poor from using the services. Yet, the mission of PNFP health units rotates around the idea of serving the poor and the disadvantaged. This leads to the need to reconcile the apparently irreconcilable: financial accessibility of services and their sustainability (Flessa 1998). Health managers at all levels (regional, district, sub-district, hospital, lower level health units) are ignorant about the actual cost of the services they produce and deliver. The very notion of “cost” is not clear to the great majority of them. In most cases the terms “cost” and “price” are used as if they meant the same. In the best cases, only direct costs are thought of when trying to assign a monetary value to services produced: expenditures are mistakenly taken to equal “actual costs”. So-called “hidden costs” are rarely considered or thought of. Yet, the knowledge of actual costs incurred in producing health services, can be of great use to health managers at all levels to make more informed decisions and to assess efficiency and effectiveness (Shepard et al. 2000, Green et al. 2001). In addition, a more detailed knowledge of actual costs of producing services can be useful for “political” reasons. All too often, lay people as well as technicians, seem to equate “fees” with “profit”. Sound information on actual costs of producing services, obtained with a clear and acceptable methodology, can help in clarifying the above mentioned misunderstanding. The authors of this study used cost finding and cost analysis techniques to calculate the actual cost of producing final units of outputs in Lacor Hospital, Gulu District, Northern Uganda.
Economic Impact of Lacor Hospital on the Surrounding Area
(Uganda Martyrs University, Department of Health Sciences, 2003-12) Maniple Everd; Akello Evelyn; Asio Salome; Auma Vento; Kazibwe Francis; Lule Haruna; Corrado Bruno; Odaga John
The health care industry is an important contributor to the economy, especially to that of the area surrounding health institutions. This effect is even more marked in the case of rural facilities. At national level, it comes in the form of ensuring a healthy productive population and saving costs that would have otherwise been spent on treatment, thus liberating them for use on other developmental purposes. However, being a labour-intensive industry, it also contributes by providing employment for a significant section of the working-age population. At local level, in addition to the general benefits mentioned above, it comes in the form of attracting significant government and external investment to the area, and providing a market for local goods and services. It also helps to ‘keep health dollars at home’by ensuring that locals are treated within their area and thus retaining their health expenditure within their own economy. Yet, the economic impact of the health care industry is still under-estimated the world over, Uganda inclusive. Until recently, most studies of economic impact concentrated on the contribution of activities other than health care (Scorsone 2001; Scorsone 2002) and as such, there are few articles available to be reviewed about healthcare. Although healthcare contributes to economic growth, some studies have not found it to be among the leading causes of rural economic growth. In a study of rural USA, presence of healthcare services was not perceived by the respondents to be even one of the top 25 causes of rural economic growth (Aldrich and Kusmin 1997). This study in Lacor was therefore done to try to identify and highlight the economic contribution of St. Mary’s Lacor Hospital to the war-torn Gulu region of northern Uganda, which contribution though quietly perceived, has never been quantified and, as such, appears to have been ignored. By the economic impact of an organisation on an area, we refer to the influence of that organization on the local economy in terms of the level of economic activity generated as a result of the presence of that organisation. This could be the amount of money it injects into the area from its budget, the employment it provides, the goods and services it consumes from the area thus providing a market for them, the money it attracts to the area from the government, donors and researchers, and its role in the attraction and retention of businesses and other gainful economic activity in that area. The net economic impact of such an organisation is, therefore, the expansion or contraction of an area’s economy. This should, however, be distinguished from the gross economic effects due to mere influence on the jobs, businesses or incomes (Weisbrod and Weisbrod 1997). The diagram below shows a model of the interaction between an industry like a healthcare institution producing health care and the community, containing other industries and households. The institution absorbs inputs from outside the local economy and uses some from the local economy to produce its products. Its products are consumed by the local community and beyond. The institution may also make expenditures and investments outside the local economy as shown in this second model. Economic impact studies try to measure the direct, indirect and induced effects of an institution on the economy. The institution’s direct expenditure, such as when a hospital pays its local staff, is a direct input into the local economy. Purchase of goods and contracted services from the local area such as office and medical supplies, kitchen, cleaning and laundry supplies, masonry etc. is an indirect input. When the employees of the health care institution and those of its suppliers of goods and services get and spend their money in the local economy, this is an induced impact on that economy due to the presence of that institution. Thus, initial expenditures in the health sector cause a ripple of expenditures in the economy, the so-called ‘ripple effect’. The health sector and hospitals in particular are regarded by many a policy maker as economic ‘black boxes’, merely absorbing resources with, in most cases, no light on how they spend them or as ‘bottomless black holes’ consuming resources on end. Rarely are they seen as “economic boosters” or ‘productive’ entities. In reality, however, the health sector leads to the creation and thriving of support business and payment of taxes around it (Philippakos et al. 2002). That is not to mention the economic impact that is gained by the local economy when the people are treated and gain energy to produce or the gains due to the cost of illness and death saved by receiving health education on health promotion and prevention of illness or actually being treated or rehabilitated in the hospital. Apart from health care provision at various levels, Lacor hospital makes similar economic contributions to the area of Gulu District.