Orthopaedic Outreach Program in Uganda: A Strategy to Improve Inequality in Service Delivery between Rural and Urban Communities

ABSTRACT

Background: Musculoskeletal diseases are on the increase worldwide. Greater than 80of Ugandans live in rural areas; facing formidable barriers to specialized care. In 1991 the Orthopedics Outreach Program (OOP) was initiated as a plausible solution to the inequity of orthopedic care between the urban and rural disadvantaged populations. This investigation was conducted to evaluate the output; effectiveness; and barriers to access; of the OOP over 13 years. Methods: This was a retrospective analysis to quantify surgical output and effectiveness of the OOP using the outreach record and a cross-sectional analysis to assess access and efficacy of the program. Semi-structured and key informant interviews targeted to key actors involved in the OOP were conducted to provide a qualitative assessment of the program. Results: Sixty seven outreach visits were completed; 6;653 patients seen; and 1;071 surgeries performed; at a total cost of US$12;701.00. The cost per patient seen was US$1.91 and US$11.86 per surgery performed. Poverty was uniformly cited as barrier to access; others were; transportation; and lack of awareness. There was unanimous opinion on the worthiness and effectiveness of the OOP; but many operational issues and constraints were cited. Conclusion: The OOP may provide a short and medium term solution to equity and access for orthopedic care in Uganda. There is need to quantify the burden of specific orthopedics conditions. A follow-up analysis assessing operational efficacy and output from 2004 to date; under the African Medical and Research Foundation (AMREF) and Ministry of Health funding is recommended