Browsing by Author "Odaga John"

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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.
From Alma Ata to Millennium Development Goals: To What Extent Has Equity Been Achieved?
(Uganda Martyrs University, Department of Health Sciences, 2004-04) Odaga John
Equity was a core value in the Alma Ata declaration on PHC. However, the interpretation of equity varied and its application became difficult. Equity goals and objectives have often been rhetoric rather than practical. Policy reforms since Alma Ata have been dominated by the neo-liberal economic ideology, which does not include equity as its core value. After 25 years, reforms such as the essential health package, sector-wide approach, user-fees and decentralization have not achieved the key goals of PHC such as equity, and of health sector reforms such as cost recovery, efficiency and sustainability.
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.
The quality and use of maternal health care in Oyam district, Uganda:
(Uganda Martyrs University Press, 2009-04-01) Birungi Sixtus; Odaga John; Lochoro John Peter; Santini Stefano; Owiny Vincent; De Vivo Emmanuela
Despite the availability of technically sound approaches, maternal mortality and other reproductive health problems persist in Uganda and other developing countries. Utilisation of maternal health services remains very low, especially delivery attended by skilled birth attendants. In Oyam and other Ugandan districts smarting out of prolonged insurgency, reproductive health services are generally poorly utilised. Doctors with Africa-CUAMM, an Italian NGO, together with other partners and with funding from the EU, initiated a programme intended to improve the uptake and quality of reproductive health services in Oyam District. A baseline study was conducted in 2008 to document the initial pattern of use and quality of the existing maternal healthcare services in order to generate baseline data against which the performance of the programme will be evaluated. Its objectives were to establish the level of utilisation of maternal healthcare; the factors underlying mothers' health-seeking behaviour; the quality of maternal healthcare services; and to describe the outcome of pregnancies carried within the previous 5 years. The study had three major components: a household survey (1472 households); a survey of community resource persons (30 TBAs, and 9 senior women leaders); and a health facilities survey (1 hospital, 1 HC IV, and 5 HC IIIs). Government-owned facilities were the most prevalent and most utilised (by 84.7%). The median age of the mothers at the last pregnancy was 24 years and by that age, most mothers had had 3 pregnancies. At the first onset of labour, most women consulted an untrained friend or relative, and TBAs due to proximity. Overall, 41% of the deliveries in the district take place in health facilities, and 44% at the TBAs but 3.2% are not attended to. PNC services are not well utilised despite high levels of awareness of the presence and utility of the services (by 73%). Most mothers utilize injectable hormonal contraceptives and natural methods. Resistance from spouses and perceived negative effects of FP methods are major hindrances to FP utilisation. Over 90% of the pregnancies had a positive outcome for the mother and child. The study recommends focusing on quality improvement through implementation of the standard package of reproductive health services and support supervision.
The Quality and Use of Maternal Health Care in Oyam District, Uganda: A baseline survey for an intervention
(Department of Health Sciences of Uganda Martyrs University, 2015-11-15) Birungi Sixtus; Odaga John; Santini Stefano
Despite the availability of technically sound approaches, maternal mortality and other reproductive health problems persist in Uganda and other developing countries. Utilisation of maternal health services remains very low, especially delivery attended by skilled birth attendants. In Oyam and other Ugandan districts smarting out of prolonged insurgency, reproductive health services are generally poorly utilised. Doctors with Africa-CUAMM, an Italian NGO, together with other partners and with funding from the EU, initiated a programme intended to improve the uptake and quality of reproductive health services in Oyam District. A baseline study was conducted in 2008 to document the initial pattern of use and quality of the existing maternal healthcare services in order to generate baseline data against which the performance of the programme will be evaluated. Its objectives were to establish the level of utilisation of maternal healthcare; the factors underlying mothers' health-seeking behaviour; the quality of maternal healthcare services; and to describe the outcome of pregnancies carried within the previous 5 years. The study had three major components: a household survey (1472 households); a survey of community resource persons (30 TBAs, and 9 senior women leaders); and a health facilities survey (1 hospital, 1 HC IV, and 5 HC IIIs). Government-owned facilities were the most prevalent and most utilised (by 84.7%). The median age of the mothers at the last pregnancy was 24 years and by that age, most mothers had had 3 pregnancies. At the first onset of labour, most women consulted an untrained friend or relative, and TBAs due to proximity. Overall, 41% of the deliveries in the district take place in health facilities, and 44% at the TBAs but 3.2% are not attended to. PNC services are not well utilised despite high levels of awareness of the presence and utility of the services (by 73%). Most mothers utilize injectable hormonal contraceptives and natural methods. Resistance from spouses and perceived negative effects of FP methods are major hindrances to FP utilisation. Over 90% of the pregnancies had a positive outcome for the mother and child. The study recommends focusing on quality improvement through implementation of the standard package of reproductive health services and support supervision..
Rapid diagnostic tests versus clinical diagnosis for managing people with fever in malaria endemic settings (Review)
(JohnWiley & Sons, Ltd., 2014) Odaga John; Sinclair D; Lokong J. A.; Donegan S; Hopkins H; Garner P
In 2010, theWorld Health Organization recommended that all patients with suspected malaria are tested for malaria before treatment. In rural African settings light microscopy is often unavailable. Diagnosis has relied on detecting fever, and most people were given antimalarial drugs presumptively. Rapid diagnostic tests (RDTs) provide a point-of-care test thatmay improvemanagement, particularly of people for whom the RDT excludes the diagnosis of malaria. The objectives were to evaluate whether introducing RDTs into algorithms for diagnosing and treating people with fever improves health outcomes, reduces antimalarial prescribing, and is safe, compared to algorithms using clinical diagnosis. We searched the Cochrane Infectious Disease Group Specialized Register; CENTRAL (The Cochrane Library);MEDLINE; EMBASE; CINAHL; LILACS; and the metaRegister of Controlled Trials for eligible trials up to 10 January 2014. We contacted researchers in the field and reviewed the reference lists of all included trials to identify any additional trials. Individual or cluster randomized trials (RCTs) comparing RDT-supported algorithms and algorithms using clinical diagnosis alone for diagnosing and treating people with fever living in malaria-endemic settings. Two authors independently applied the inclusion criteria and extracted data. We combined data from individually and cluster RCTs using the generic inverse variance method. We presented all outcomes as risk ratios (RR) with 95% confidence intervals (CIs), and assessed the quality of evidence using the GRADE approach. We included seven trials, enrolling 17,505 people with fever or reported history of fever in this review; two individually randomized trials and five cluster randomized trials. All trials were conducted in rural African settings. In most trials the health workers diagnosing and treating malaria were nurses or clinical officers with less than one week of training in RDT supported diagnosis. Health worker prescribing adherence to RDT results was highly variable: the number of participants with a negative RDT result who received antimalarials ranged from 0% to 81%. Overall, RDT supported diagnosis had little or no effect on the number of participants remaining unwell at four to seven days after treatment (6990 participants, five trials, low quality evidence); but using RDTs reduced prescribing of antimalarials by up to threequarters (17,287 participants, seven trials, moderate quality evidence). As would be expected, the reduction in antimalarial prescriptions was highest where health workers adherence to the RDT result was high, and where the true prevalence of malaria was lower. Using RDTs to support diagnosis did not have a consistent effect on the prescription of antibiotics, with some trials showing higher antibiotic prescribing and some showing lower prescribing in the RDT group (13,573 participants, five trials, very low quality evidence). One trial reported malaria microscopy on all enrolled patients in an area of moderate endemicity, so we could compare the number of patients in the RDT and clinical diagnosis groups that actually had microscopy confirmed malaria infection but did not receive antimalarials. No difference was detected between the two diagnostic strategies (1280 participants, one trial, low quality evidence). Algorithms incorporating RDTs can substantially reduce antimalarial prescribing if healthworkers adhere to the test results. Introducing RDTs has not been shown to improve health outcomes for patients, but adherence to the test result does not seem to result in worse clinical outcomes than presumptive treatment. Concentrating on improving the care of RDT negative patients could improve health outcomes in febrile children.