Browsing by Author "Govule, Philip"

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Application of workload indicators of staffing needs (WISN) in determining health workers' requirements for Mityana general hospital, Uganda
(International Journal of Public Health Research, 2015-08-30) Govule, Philip; Mugisha, John Francis; Katongole, Simon Peter; Bikaitwoha, Maniple Evard; Nanyingi, Miisa; Anguyo, Robert; Onzima, DDM
With reducing number of health workers amidst increasing disease burden, ever increasing population and limited resources, health systems are faced with challenges of providing adequate and quality health care globally. The application of provider-population ratio or fixed staff establishments have overtime, not matched the changing human resource needs of health care organizations. This study aimed to estimate human resource requirements of Mityana hospital basing on workload as an alternative to the existing approaches. Methodology: We employed descriptive cross-sectional design and the Workload Indicator of Staffing Needs (WISN) methodology. We utilized focus group discussion, observation and document review to obtain information from key informants; generated annual service statistics from the hospital’s records. The quantitative data were analyzed using the WISN software and spread sheet. Results: All the cadres studied had the same hours of work in a year (1,664), except nursing assistants whose annual available working time was1,696 hours. All the cadres were experiencing additional workload due to use of their time for activities other than their primary duties. Medical officers used more than 50% of their time for such (non-primary) activities compared to the laboratory staff (15%). As a result, the calculated WISN staff requirements were very high compared to the existing staff levels. Mityana hospital had 44% of the posts filled for the studied cadres. The nurses and midwives had the highest calculated requirements (72 and 45 respectively) and the highest staff positions filled (57% and 84% respectively) making them experience the lowest work pressure (49% each). The highest work pressure was experienced by medical officers and medical clinical officers (82% each). Conclusion: The study reveals shortages in health workforce in Mityana hospital. Non-primary activities contributed to work pressure in different units of the hospital, resulting into long hours of shifts which could have compromised quality of health care. This method (WISN) estimates staffing requirements based on actual service provision. Stakeholders facing human resource challenges and scarcity can employ it in prioritizing health cadres for recruitment and deployment based on existing work pressure.
Communities’ Willingness to Pay for Healthcare in Public Health Facilities of Nakasongola District, Uganda
(International Journal of Public Health Research, 2015-08-20) Dakoye, Damali; Anguyo, Robert Onzima; Govule, Philip; Katongole, Simon Peter; Ayiko, Rogers; Nabyonga-Orem, Juliet
Poor countries continue to register decreasing revenue to finance health care amidst rising demand with consequently growing out of pocket expenditure on health exceeding 35% of the total health care expenditure; this scenario is observed in more than three quarter of Sub-Saharan African countries. For Uganda, the situation is even worse with about half of the national health expenditure financed from out of pocket despite tax-based national health services. In response, Uganda’s Ministry of Health has placed health insurance at centre of financing health care in the medium term. This paper examines willingness to pay for health care in line with the planned policy of Uganda. We evaluated: willingness to pay for the health care in public health facilities; household characteristics associated with willingness to pay; how much households were willing to pay; and the preferred mode of payment. Methods: We interviewed 376 household heads or their representatives in four sub-counties of Nakasongola district for willingness to pay for the current or improved quality of health care in public health facilities. In order to explore how much the households were willing to pay per capita member of household per annum, we employed the contingency valuation method using the ‘open-ended’ bidding game. Results: Majority, 56.7% (199) of the respondents were not willing to pay for health care in public health facilities at the current level of quality. Willingness to pay grew from 43.3% (152) to 83.5% (293) for improved quality of care in public health facilities. Major operations, in-patient therapeutic care and health facility deliveries in that order were the services communities were most willing to pay for if quality of care matched their expectation. The median willingness to pay was Ugandan shillings 4,888 ($1.56) (range 0-10,000 [$3.19]) and once-annual prepayment was preferred by majority of respondents. Female-household headship, high-level of education of household head and belonging to lower income quintiles were positively associated with willingness to pay. Conclusion: The communities in Nakasongola district are willing to pay for health care in public health facilities provided the quality of care is improved. Given the low median amount of willingness to pay and the fact that persons from poor households were more willing to pay, planners of Health Insurance programs should devise progressive premium calculation mechanisms and further plan for government subsidy in order to take care of the poor.
Determining Healthcare Workforce Requirements for Kuluva Hospital in West Nile-Uganda, using the Workload Indicators of Staffing Need (WISN)
(Research Square, 2023-04-29) Anguyo DDM Onzima, Robert; Govule, Philip; Apangu, Titus; Harogha, Alan; Wibale, Wilson; Debo, Ronald; Ambayo, Richard; Lulua Awudo, Jimmy; Maryekmungu, Immaculate; Likico Bayoru, Aziku Celina; Nanyingi, Miisa; Karengera, Innocent
Health workforce shortage is a major threat to global public health with a greater implication for low resourced countries. The right placement of the available staff in many health facilities remains a challenge due to inadequate information on exact workload and work pressure that staff undergo in course of work. This study aimed to determine the need for key health workforce cadre in Kuluva hospital using Workload Indicators of Staffing Need (WISN) methodology. The study followed a predominantly quantitative approach of Workload Indicator Staffing Needs (WISN) methodology. We held a meeting with hospital management to understand policy issues and procedures. The key staff were interviewed in departments, available records reviewed, practices observed to establish the available working time, activity standards and time taken to perform other supportive activities. Service statistics was generated from HMIS data of 2016/17. Data was analyzed manually using calculator and Microsoft Excel spreadsheet. All cadre categories had the same available working time of 1,504 hours in a year with 105 staff of the studied cadres required to perform all activities in Kuluva hospital based on WISN calculation. Although overall work pressure was 30%, 5 out of 7 staff cadre categories experienced work pressure of varying degrees – medical officers (70%), laboratory staff (70%) and clinical officers (60%) were most affected compared to nurses (30%) and midwives (10%). There was perfect number of anesthetists but surplus nursing assistants than needed by the hospital. Amidst shortage, the critical cadres still spent significant time on non-professional activities; medical officers (24%) and midwives (25%). These findings can provide insight into the management of Kuluva hospital to address the current disparities in the health workforce in terms of numbers and skill mix for continuous improvement of health service delivery to the population it serves.
Improving Partograph Documentation and Use by Health Workers of Bwera Hospital
(Open Science, 2015-06-20) Katongole, Simon Peter; Govule, Philip; Masika, Mary Aliona
In this action based research we undertook a pragmatic quality-improvement approach to the research. This article describes improvements realized when an action research was carried out on maternity department in Bwera Government hospital Kasese district. We describe how practice research engagement was employed in the maternity department to contribute to health service improvement. The action research was carried between the months of June to August 2014, the study aimed at improving partograph documentation and use by midwives and doctors working in the department. The study used an exploratory, descriptive process improvement research to determine the most pressing problem on the department that required urgent improvement. Problems identified included inadequate infection prevention, poor partograph use and documentation, Comprehensive Emergency Obstetric and Neonatal Care (CEmONC), and failure to adhere to the 5S principles. Through pairwise ranking, inadequate partograph documentation and use by midwives and doctors while assisting mothers to deliver was the prioritized problem that required urgent improvement. Basing on guidelines adopted from the Ministry of Health by Engender Health Project on correct use and documentation of partograph, the number of deliveries conducted and had all the 18 (100%) indicators of the partograph monitored and documented stood at 8.3%. This, therefore, led to training all midwives and doctors working on maternity ward on correct use and documentation of a partograph, increase attachment of partographs to clients’ files and address the practice of leaving partographs blank. The research targeted to increase the percentage of mothers monitored in labour by the correct documentation and use of the partograph. Monitoring of mothers through correct documentation and use of the Partograph at maternity department improved to 89.3%. Marked changes were realized in attaching partographs on clients’ files from 96% to 99% and reduction of partographs left blank from 8% to 3%. It is therefore recommended that clinical leadership, continuous professional development and support supervision on partograph use and documentation be emphasized in
Malaria treatment health seeking behaviors among international students at the University of Ghana Legon
(PLOS, 2023-10-26) Lwenge, Mathias; Govule, Philip; Katongole, Simon Peter; Dako-Gyeke, Phyllis
Appropriate management of malaria demands early health seeking behaviour upon suspicion of malaria-like symptoms. This study examined malaria treatment seeking behaviour and associated factors among international students at University of Ghana. The study used a cross-sectional and quantitative approach. Data collection was undertaken using a structured questionnaire administered on a random sample of 264 international students. Data obtained on malaria treatment and factors influencing treatment behaviors were analyzed using IBM, SPSS Statistics version 22. Associations between individual characteristics and Malaria treatment seeking behavior was assessed by Pearson Chi-square(X2) test of independence. Binary logistic regression model was built using a backwards Wald approach, with variables retained at Wald p-value <0.05. The findings show that 35% of the respondents obtained self-prescribed antimalarial at their utmost first choice of Malaria treatment. At bivariate level, a significant relationship between Malaria health-care seeking behaviour and:- Respondents continent, X2(1, N = 264) = 7.936, p = .005; Service accessibility, X2(1, N = 264) = 7.624, p = .006; Wait time, X2(1, N = 264) = 22.514, p <0.001; Treatment cost, X2(1, N = 264) = 97.160, p <0.001; Health insurance, X2(1, N = 264) = 5.837, p = 0.016, and Perceived staff attitude, X2(1, N = 264) = 18.557, p < 0.001. At multivariable analysis, inappropriate malaria health seeking behaviours was associated with low perceived service accessibility as (≥30mins) (aOR = 6.67; p<0.001), perceived long wait time (≥30mins), (aOR = 5.94; p = 0.015), perceived treatment cost affordability (<15 GHC) (aOR = 19.88; p<0.001) and age group: -34-41years (aOR = 8.83; p<0.001). There were widespread inappropriate health-care seeking behavior for Malaria treatment among international students. Improving accessibility to malaria treatment services, reducing wait time at health facilities and the treatment cost will address inappropriate malaria treatment health seeking behaviours among the international students.
Prevalence and drug susceptibility of isolates of urinary tract infections among febrile under-fives in Nsambya Hospital, Uganda
(Open Science Journal of Clinical Medicine, 2015) Katongole, Simon Peter; Ocokoru, Christine; Onzima, Robert Anguyo DDM; Govule, Philip
Background: Urinary tract infections remain a silent cause of morbidity and complications among under-fives due to its nonspecific presentation and incapacity of most health facilities in developing countries to diagnose it. Earlier studies present different prevalence of urinary tract infections among children. This study aimed to document prevalence and drug susceptibility patterns of isolates of bacterial urinary tract infections among under-fives in Nsambya hospital, Uganda. Methodology: We conducted a descriptive cross-sectional survey among 302 under-fives who presented in paediatric ambulatory care department of Nsambya hospital with fever (axillary temperature of >37.5°C or by history); and with no history of antibiotic therapy within three days preceding hospital visit. Midstream urine samples collected using bag and bottle collection (depending on age of child) were subjected to culture. We further subjected culture-positive urine samples to systematic bacteriologic and biochemical tests in order to identify the organisms in the colonies before performing drug susceptibility tests. Results: We found urinary tract infection prevalent in 26.8% of the under-fives. Bacterial isolates responsible for the infections were Proteus (39.5%), Escherichia coli (32.1%), Staphylococcus aureus (14.8%), Klebsiella spp. (6.2%), Staphylococcus haemolyticus (2.5%), Staphylococcus intermedius (2.5%), Citrobacter (1.2%) and Morganella (1.2%) in that order. The pathogens exhibited high-level of resistance to commonly used antibiotics like Cotrimoxazole, Amoxicillin, Nalidixic Acid, Nitrofurantoin, Gentamicin, Erythromycin, Chloramphenicol, Ampicillin, Ciproflaxin, Tetracycline and Azithromicin while the isolates showed no resistance to pharmaco-enhanced Amoxicillin and oral Cefatoxime. Conclusion: Prevalence of UTI among febrile under-fives in Nsambya hospital is higher than reports from majority of earlier studies. Similarly, the commonest bacterial isolates associated with UTI among under-fives in Nsambya hospital deviates from most studies in developing countries that majorly report Escherichia coli as the leading cause of UTI in this age category. The observed resistance patterns associated with common antibiotics in our study are in line with the current changing patterns of microbial-antibiotic resistance threatening not only the developing world but the entire glob.
Quality and Use of Routine Healthcare Data in Selected Districts of Eastern Province of Rwanda
(International Journal of Public Health Research, 2016-05-03) Karengera, Innocent; Anguyo, Robert. DDM Onzima; Katongole, Simon Peter; Govule, Philip
Strengthening of Health Management Information System (HMIS) is becoming an unavoidable task for most health systems in the World. As part of the strengthening (of HMIS), it is imperative that stakeholders undertake periodic studies on HMIS-data quality so as to gain insight into the level of quality and cause corrective action. This study evaluated the quality of HMIS, factors influencing quality (of HMIS), use of data generated from HMIS and factors influencing use of data in 3 districts of Eastern Province of Rwanda. We employed a descriptive cross-sectional study design focusing on 9 months from 1st July 2012 to 31st March 2013. To achieve this we conducted HMIS data quality assessment through checking of presence of selected registers and client/patients’ cards, deviations between reported patient statistics and those in the appropriate registers, reports with at least 95% of the data fields well filled, expected reports received at the receiving hospitals, reports received by due date and evidence of data use from a set of criteria. We further conducted key informants interviews with the health facility managers and records officers on factors influencing the observed data quality; use of data and associated factors. We found that though every ‘register of interest’ was available in all the health facilities, client/patients’ cards experienced severely stock out over the months under study. Low proportion of health facilities attained the a priori for availability of ANC cards (58.0%), Partograms (56.8%), Child Health Cards (59.5%), Family Planning user cards (78.1%) and Outpatient medical forms (57.4%). High proportion of health facilities had good quality of (accurate) health facility reports (73.3%) and those in the electronic data base (70.6%). Similarly, high proportion of health facilities met the quality standard for content completeness (97.6%) in addition to high proportion of expected reports received at the receiving hospitals (97.7%). The overall timeliness of reporting of HMIS monthly reports stood at 93.8%. Data were rarely used in the health facilities and this was majorly enhanced by the top-down approach to setting of targets and planning. We concluded that levels of data accuracy, completeness and timeliness in the situation of Rwanda did not match the rhetoric that data quality in health systems in developing countries is poor. The few lapses identified could have been associated with factors we did not statistically verify. Use of data in our study health facilities was inadequate and the self-reported use (of data) could not be backed by evidence from our observations. The top-down nature of planning greatly prevented the operational-level managers from using data.
Relationship Between Management Practices and Employee Absenteeism in Public General Hospitals of East-Central Uganda
(International Journal of Public Health Research, 2015-11-17) Wananda, Irene; Byansi, Peter Kayiira; Govule, Philip; Katongole, Simon Peter; Wampande, Lillian Nantume; Anguyo, Robert DDM Onzima
Effective management practices play a pivotal role in influencing positive behavior among employees at the work place [1]-[2]. Absenteeism of employees signals organizational ill health. Studies indicate that management practices can negatively or positively influence the employee absence rate in an organization [3]. This study assessed the relationship between management practices and health worker absenteeism in public general hospitals in East Central Uganda. It was prompted by the findings of Medicines and Health Services Delivery Monitoring Unit [4] that health worker absenteeism was rampant in Uganda. The study objectives were: to find out the magnitude and causes of health worker absenteeism in public general hospitals in East Central Uganda, establish the relationship between performance management practices and health worker absenteeism, establish the relationship between attendance and absence management practices and absenteeism, finally to establish the relationship between employee motivation and absenteeism. The study employed a mixed research design. Data were collected from 46 key informants, 220 health workers and 3 focus group discussions (FGDs). An absenteeism tracking tool was also used as a measure of health worker absenteeism. Descriptive statistics, frequency distributions and logistic regression were employed for data analysis alongside content analysis. Findings revealed that socio-demographic factors, performance management practices; attendance and absence management practices; and employee motivation practices did influence absenteeism. We concluded that Magnitude of absenteeism is still of management importance (influenced by management practices and socio-demography) and varied by hospital, time of assessment and day of the week. The implementation of management practices varied from one hospital to another – strengthening the performance management practices; attendance and absence management practices; and employee motivation practices while addressing the socio demographic characteristics (that predict absenteeism) along the continuum of the hierarchy of needs could further reduce absenteeism.