Browsing by Author "Kirunga Tashobya, Christine"

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    Health systems performance assessment in low-income countries: learning from international experiences
    (Globalization and Health, 2014) Kirunga Tashobya, Christine; da Silveira, Valéria C.; Ssengooba, Freddie; Nabyonga-Orem, Juliet; Macq, Jean; Criel, Bart
    The study aimed at developing a set of attributes for a ‘good’ health system performance assessment (HSPA) framework from literature and experiences in different contexts and using the attributes for a structured approach to lesson learning for low-income countries (LICs). Methods: Literature review to identify relevant attributes for a HSPA framework; attribute validation for LICs in general, and for Uganda in particular, via a high-level Ugandan expert group; and, finally, review of a selection of existing HSPA frameworks using these attributes. Results: Literature review yielded six key attributes for a HSPA framework: an inclusive development process; its embedding in the health system’s conceptual model; its relation to the prevailing policy and organizational set-up and societal context; the presence of a concrete purpose, constitutive dimensions and indicators; an adequate institutional set-up; and, its capacity to provide mechanisms for eliciting change in the health system. The expert group contextualized these attributes and added one on the adaptability of the framework. Lessons learnt from the review of a selection of HSPA frameworks using the attributes include: it is possible and beneficial to involve a range of stakeholders during the process of development of a framework; it is important to make HSPA frameworks explicit; policy context can be effectively reflected in the framework; there are marked differences between the structure and content of frameworks in high-income countries, and low- and middleincome countries; champions can contribute to put HSPA high on the agenda; and mechanisms for eliciting change in the health system should be developed alongside the framework.
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    Health Systems Reforms in Uganda: Processes and Outputs
    (Health Systems Development, 2006) Kirunga Tashobya, Christine; Ssengooba, Freddie; Cruz, Valeria O.
    During the 1970s and 1980s, Uganda went through a period of political and economic upheaval, resulting in the breakdown of many services. In the health sector this was characterized by general system failure. Funding was grossly insufficient, leading to problems of meagre and late salaries for health workers, permanent shortages of medicines and supplies, and dilapidated infrastructure. The National Resistance Movement, headed by President Yoweri Museveni, took power in 1986. Initial efforts by this government were focused on the restoration of law and order and on the reestablishment of public systems. However, there was minimal government funding available for social services including the health sector. Many bilateral and multilateral donors intervened to provide post-conflict support including emergency rehabilitation of the health infrastructure. These international agencies focused their support on specific aspects of the health sector (usually disease programmes) in particular parts of the country. Districts which were closer to the capital city and easily accessible attracted many donor projects, while districts which were remote and difficult to access received few or no projects at all.
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    Uptake of evidence in policy development: the case of user fees for health care in public health facilities in Uganda
    (BMC health services research, 2014) Nabyonga-Orem, Juliet; Ssengooba, Freddie; Mijumbi, Rhona; Kirunga Tashobya, Christine; Marchal, Bruno; Criel, Bart
    Several countries in Sub Saharan Africa have abolished user fees for health care but the extent to which such a policy decision is guided by evidence needs further exploration. We explored the barriers and facilitating factors to uptake of evidence in the process of user fee abolition in Uganda and how the context and stakeholders involved shaped the uptake of evidence. This study builds on previous work in Uganda that led to the development of a middle range theory (MRT) outlining the main facilitating factors for knowledge translation (KT). Application of the MRT to the case of abolition of user fees contributes to its refining. Methods: Employing a theory-driven inquiry and case study approach given the need for in-depth investigation, we reviewed documents and conducted interviews with 32 purposefully selected key informants. We assessed whether evidence was available, had or had not been considered in policy development and the reasons why and; assessed how the actors and the context shaped the uptake of evidence. Results: Symbolic, conceptual and instrumental uses of evidence were manifest. Different actors were influenced by different types of evidence. While technocrats in the ministry of health (MoH) relied on formal research, politicians relied on community complaints. The capacity of the MoH to lead the KT process was weak and the partnerships for KT were informal. The political window and alignment of the evidence with overall government discourse enhanced uptake of evidence. Stakeholders were divided, seemed to be polarized for various reasons and had varying levels of support and influence impacting the uptake of evidence.