What happened to the IUD in Ghana?

The intrauterine contraceptive device (IUD) is a safe and reversible contraceptive method that requires little effort on the part of the user. Once inserted, it offers 10 years of protection against pregnancy. However, its use in Ghana has stagnated in relation to other contraceptive methods. An exploratory study was, therefore, conducted to examine the client, provider and system characteristics that affect the demand for IUD. Data were gathered through secondary analysis, in-depth interviews, focus group discussions and simulated client survey. The stagnating demand for IUD is attributed to clients' perceptions and rumours about IUD. The fear of excessive bleeding and weight loss discourages potential users. The product design was also perceived to be unacceptable. Demand creation for the IUD has been poor and the number of providers with practical experience of insertion is insufficient. Contrary to the belief that providers' bias contributes to the decline in use, findings show that providers have a favourable attitude towards the product.

Injection use and practices in Uganda

This report covers the methodology of the study on injection practices in developing countries, the extent of injection use and the type and degree of improper practices in administering injections. Document in pdf format; Acrobat Reader required.

The policy on public-private mix in the Ugandan health sector: catching up with reality.

An informal public-private mix in the health sector has always existed in Uganda, and policymakers, planners and the public in general have taken this for granted. There is now renewed effort to develop a comprehensive policy on the mix, but the policy process has proved to be tortuous and the mix has been interpreted differently by different stakeholders. While significant differences in opinion on the mix still remain, it is becoming clear that the new policy should enable health institutions, whether in the public or the private sector, to play roles in which they have clear comparative advantage over others.

Are lessons from the education sector applicable to health care reforms? The case of Uganda.

The decision by donors to use external aid for poverty alleviation in very low-income countries and the redefinition of development to include human aspects of society have renewed interest in education and health services. The debate about accountability, priorities and value-for-money of social services has intensified. Uganda's universal primary education programme (UPE) has within 2 years of inception achieved 90% enrollment. The programme has been acclaimed as successful. But the health sector that has been implementing primary health care and reforms for two decades is viewed as having failed in its objectives. The paper argues that the education sector has advantages over the health sector in that its programme is simple in concept, and was internally designed involving few actors. The sector received strong political support, already has an extensive infrastructure, receives much more funding and has a straightforward objective. Nevertheless, the health sector has made some achievements in AIDS control, in the prevention and control of epidemics, and in behavioural change. But these achievements will not be noticed if only access and health-status are used to assess the health sector. However, UPE demonstrates that a universal basic health care is possible, given the same level of resources and political commitment. The lesson for the health sector is to implement a priority universal health care programme based on national values and to assess its performance using the objectives of the UPE.

Injections and self-help: risk and trust in Ugandan health care.

The paper draws upon research material collected during a one year long ethnographic study on injection use and a WHO funded Injection Practices Research Project, which were both carried out during 1992/1993. The paper examines the changing trends in injection use and practices in the context of the Ugandan health system and in relation to popular views about risk and trust. Generally, people mistrust injections provided at government health institutions and prefer to gain access to injections as symbolic tokens of healing through personal contacts and private ownership of injecting equipment. It now appears that the use of this Western biomedical technology is widespread at all levels of the health care system; needles, syringes and injectables are readily available in homes for use by families and untrained providers. In other words, the injection technology has been domesticated and personalized. The Giddens (1990) framework [Giddens, A. (1990) Consequences of Modernity. Stanford University Press, California.] concerning modernity, trust and risk is applied to understand the motivations behind these processes. The basic argument is that the weakening of state institutions of health care has been accompanied by a loss of trust in the treatment offered there. In addition, the massive anti-AIDS education campaigns which have warned people against the dangers of sharing unsterilized needles, have reinforced existing mistrust in public health facilities and induced families to seek care from people they know and using injecting equipment over which they have personal control. The paper concludes that changing the current injection practices in Uganda will necessitate a change in the organization of public health institutions.

Injections in Uganda -- cause for concern.

PIP: Uganda during the 1960s was considered to have one of the best health care systems in Africa. Injections of medicines such as penicillin and chloroquine have traditionally been a very common form of therapy in the country. Although these drugs are relevant to common diseases in Uganda, they are often administered when not necessarily called for. Injections in the 1960s were mainly administered by health workers in government dispensaries, health centers, and hospitals; missionary medical services; and in private clinics run by licensed medical practitioners. The Pharmacy and Drug Act of 1970 even made it illegal for any lay person to own a syringe for injection. Untrained neighborhood "needle men," however, still provided a limited number of injections in their communities. Civil war and economic decline beginning in 1971 weakened the government health care system such that facilities fell into disrepair and the government could not afford to supply free medicines, to maintain adequate supervision, or to pay health care workers a living wage. Government health workers treated patients in their homes, sold medicines, and demanded payment for services at government units. With widespread ownership of syringes and needles, injections are given by a wide range of providers, only half of whom have any formal training on the procedure. Providers and users of injected medicines need to be taught about the health hazards posed by frequent, inappropriate, and unsterile injections. Simple messages need to be developed about indications and procedures for injections, and nurses' aides, dressers, and informal providers afforded proper training. Efforts should be made to counter mistrust in communal sterilization, while the private ownership of injecting equipment is acknowledged. Over the long term, however, steps should be taken to get such equipment out of the hands of private owners.^ieng