Introducing quality management into primary health care services in Uganda

ABSTRACT

In 1994; a national quality assurance programme was established in Uganda to strengthen district-level management of primary health care services. Within 18 months both objective and subjective improvements in the quality of services had been observed. In the examples documented here; there was a major reduction in maternal mortality among pregnant women referred to Jinja District Hospital; a reduction in waiting times and increased patient satisfaction at Masaka District Hospital; and a marked reduction in reported cases of measles in Arua District. Beyond these quantitative improvements; increased morale of district health team members; improved satisfaction among patients; and greater involvement of local government in the decisions of district health committees have been observed. At the central level; the increased coordination of activities has led to new guidelines for financial management and the procurement of supplies. District quality of health headquarters have led to a greater uderstanding by central staff of the issues faced at the district level. The quality assurance programme has also fotered improved coordination among national disease-control programmes. Difficulties encountered at the central level have included delays in carrying out district support visits and the failure to provide appropriate support. At the district level; some health teams tackled problems over which they had little control or which were overly complex; others lacked the management capacity for problem solving