Browsing by Author "Okuonzi, Sam"

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    Can donor aid for health be effective in a poor country? Assessment of prerequisites for aid effectiveness in Uganda
    (Pan African Medical Journal, 2009) Nabyonga Orem, Juliet; Ssengooba, Freddie; Okuonzi, Sam
    Inadequate funding for health is a challenge to attaining health-related Millennium Development Goals. Significant increase in health funding was recommended by the Commission for Macroeconomics and Health. Indeed Official Development Assistance has increased significantly in Uganda. However, the effectiveness of donor aid has come under greater scrutiny. This paper scrutinizes the prerequisites for aid effectiveness. The objective of the study was to assess the prerequisites for effectiveness of donor aid, specifically, its proportion to overall health funding, predictability, comprehensiveness, alignment to country priorities, and channeling mechanisms. Methods: Secondary data obtained from various official reports and surveys were analyzed against the variables mentioned under objectives. This was augmented by observations and participation in discussions with all stakeholders to discuss sector performance including health financing. Results: Between 2004−2007, the level of aid increased from US$6 per capita to US$11. Aid was found to be unpredictable with expenditure varying between 174−360 percent from budgets. More than 50% of aid was found to be off budget and unavailable for comprehensive planning. There was disproportionate funding for some items such as drugs. Key health system elements such as human resources and infrastructure have not been given due attention in investment. The government’s health funding from domestic sources grew only modestly which did not guarantee fiscal sustainability. Conclusion: Although donor aid is significant there is need to invest in the prerequisites that would guarantee its effective use.
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    The Potential of the Private Sector to Improve Health Outcomes in Uganda
    (Makerere University Institute of Public Health, 2006) Konde-Lule, Joseph; Okuonzi, Sam; Matsiko, Charles; Mukanga, David; Onama, Virgil; Gitta, Sheba Nakacubo
    In Uganda, as in many other developing countries, the rural poor shoulder a large share of the disease burden, but the mix and roles of the health providers accessible to local communities has not been fully documented.
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    Private and Public Health Care in Rural Areas of Uganda
    (BMC international health and human rights, 2010) Konde-Lule, Joseph; Gitta, Sheba N; Lindfors, Anne; Okuonzi, Sam; Onama, Virgil ON
    In many low and middle income countries, the private sector is increasingly becoming an important source of health care, filling gaps where no or little public health care is available. However, knowledge on the private sector providers is limited The objective of this study was to determine the type and number of different types of health care providers, and the quality, cost and utilization of care delivered by those providers in rural Uganda.
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    What Could be Achieved with Greater Public Hospital Autonomy? Comparison of Public and PNFP Hospitals in Uganda
    (The International Journal of Management Research and Practice, 2002) Ssengooba, Freddie; Atuyambe, Lynn; Mcpake, Barbara; Hanson, Kara; Okuonzi, Sam
    The policy of hospital autonomy has been discussed for some time in Uganda. There is little evidence from Uganda or elsewhere that increased autonomy will improve hospital performance. This article compares the performance of three private not-forprofit (PNFP) and public hospital pairs to address this question. PNFP and public hospitals have similar management structures but PNFP hospitals had better trained managers and a church affiliated chair in the hospital management committee. Both types have problems with personnel management but these appear more pronounced in public hospitals. Drug supply management appears better in PNFP hospitals. Overall, workloads are similar, but analysis of patterns of utilisation and prices across services suggest that patient choice of facilities is influenced by relative price levels, and that willingness to pay is higher for PNFP services. PNFP hospitals are more successful at generating revenue. There are no clear differences in efficiency between PNFP and public hospitals but there is some evidence of higher quality levels in PNFP hospitals. PNFP hospitals’ performance is plausibly related to three areas of managerial autonomy. First, better management of drug supply is facilitated by their freedom to purchase drugs from the open market. Second, greater success with personnel management is plausibly related to their greater autonomy over staffing. Third, higher levels of cost recovery are enabled by their freedom to set fees. However, differences in accountability and competence of hospital management, and population willingness to pay for services may also help to explain differences. Further, the use of PNFP financing strategy by public hospitals has implications for universal access to hospital services. Although there appear to be potential advantages from greater public hospital autonomy, the Ugandan government should ensure it has developed strategies to enhance public hospital management and to protect access to public hospitals before advancing further with hospital autonomy policy