Do Ugandan Medical Students Intend to Work in Rural Health Facilities after Training?

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 (50or 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

Lifetime Experience and Management of Cases of Gender-Based Violence in the Health Facilities of Kabarole District; Uganda

Gender-based violence (GBV) is a common problem in many countries; leading to high levels of mortality and morbidity; especially of women. In the health sector; GBV presents in a cryptic manner due to fear by the victims; poor records; culture; inadequate staffing and inadequate equipment. In developing countries; there is also a lack of policies; standards and guidelines for case management. As a result; GBV cases are never recognized and are poorly managed. This study set out to assess the management of GBV victims in health facilities of Kabarole District; western Uganda. It aimed at profiling the common forms of GBV; the lifetime experience of GBV by ordinary residents; the accessibility of health services to GBV victims; the health services rendered to them and to analyse inter-sectoral collaboration on GBV issues. A descriptive cross-sectional study involving 400 respondents; 40 key informants and 2 FGDs was done in May and June 2006. Over 96of the respondents had ever experienced a form of GBV and women were more likely to have experienced it than men. Most were likely to have experienced physical violence. Female respondents were more likely to have abused their victims verbally while the males were more likely to have abused them physically. Most cases of GBV were domestic and were never reported to any authorities or to the health system unless they had led to severe physical injury. This was due to cultural restrictions on discussing domestic matters publicly. GBV survivors also often lacked funds for transport and processing the cases either with the health services; local authorities or police. They reported long waiting times at health facilities; absence of staff; lack of privacy and lack of medicines as the common problems they faced at health facilities. The range of health care services provided to GBV survivors was very narrow and mostly on request by the police. Apart from being insufficient and absent; health workers were not trained in screening for GBV; management of cases and conducting forensic investigations. They did not probe actively for possible history or evidence of GBV and the data were never disaggregated within the HMIS. Intersectoral collaboration on GBV was limited to preparing police dossiers and court testimony. The paper recommends the formulation of a national policy on GBV; and the setting up of standards and guidelines for case management in the health sector. It also recommends adequate equipment of district level facilities for sufficient forensic investigations as well as training of health workers in case management including counseling. It recommends institutionalization of GBV data collection through revision of the HMIS and Continuing Medical Education. Finally; it recommends wider inter-sectoral collaboration in order to enhance prevention of GBV at community level

Factors Related to the Uptake of Natural Family Planning by Clients of Catholic Health Units in Masaka Diocese; Uganda

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 100effective. 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

The Challenges of Managing Government-Seconded Health Workers in Private not-for-Profit Health Facilities of Kibaale District; Uganda

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 48of 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 government-seconded 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