ABSTRACT
OBJECTIVE: To document the effects of the abolition of user fees on utilization of health services in Uganda with emphasis on poor and vulnerable groups. METHODS: A longitudinal study using quantitative and qualitative methods was carried out in 106 health facilities across the country. Health records were reviewed to determine trends in overall utilization patterns and use among vulnerable groups. A modification of wealth ranking as defined by the Uganda Poverty Participatory Assessment Project was used to categorize households by socio-economic status in order to compare utilization by the poor against that of other socio-economic groups. FINDINGS: There was a marked increase in utilization in all population groups that was fluctuating in nature. The increase in utilization varied from 26% in public referral facilities in 2001, rising to 55% in 2002 compared with 2000. The corresponding figures for the lower level facilities were 44% and 77%, respectively. Increase in utilization among the poor was more than for other socio-economic categories. Women utilized health services more than men both before and after cost-sharing. Higher increases in utilization were noted among the over-five age group compared with the under-fives. There were no increases in utilization for preventive and inpatient services. With respect to quality of care, there were fewer drug stock-outs in 2002 compared with 2000 and 2001. There was no deterioration of other indicators such as cleanliness, compound maintenance and staff availability reported. CONCLUSION: The study suggests that there is a financial barrier created by cost-sharing that decreases access to services, especially among the poor in Uganda. However, further studies are needed to clarify issues of utilization by age and gender.
Subject(s)
Cost Sharing , Poverty , Age Factors , Ambulatory Care/statistics & numerical data , Fees, Medical , Female , Humans , Longitudinal Studies , Male , Patient Admission , Preventive Health Services/statistics & numerical data , Sex Factors , Socioeconomic Factors , UgandaABSTRACT
A study to assess the operationality of district health systems was carried out between February and May 2001. Operationality is defined as the state of the existing and functional structures and managerial processes that enable the provision of essential health care to the population. This was not an assessment of the performance of the district; but rather the availability of functional inputs required for health care delivery. A health care system is assessed in terms of the structures/inputs it has for health care provision; the processes used to convert these inputs into favorable products; and the outcomes that are achieved as a result of the actions of the system. The performance of a health system is a function of the available inputs; and the efficiency with which these inputs are utilized. We need to first determine the presence of inputs; before determining how these are used. The level of inputs into the health care system has not been determined. Different programs have some ideas as to the amount of input they have; but no study has ever comprehensively looked at inputs into te district system. This study quantifies the inputs into a score that can be compared over time and whithin districts for inter district comparisons. The study was very comprehensive; and this paper is a condensation of the findings. We explored thestructures/inputs that avail the users with an opportunity to receive adequate care. These features do not tel us whether the users are receiving quality care; but rather; they tell us whether there is an increased / decreased likelihood of receiving quality care. We do not explore the level of functioning of the inputs analysed; but rather the presence or absence of these inputs. Efficiency with which these inputs are utilized is a second stage of this analysis
