NRU :: Browsing by Author "Rutebemberwa, Elizeus"

Browsing by Author "Rutebemberwa, Elizeus"

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Analysis of selected policies towards universal health coverage in Uganda: the policy implementation barometer protocol
(Archives of Public Health, 2018) Ssengooba, Freddie; Hongoro, Charles; Rutebemberwa, Elizeus; Twalo, Thembinkosi; Mwendera, Chikondi; Douglas, Mbuyiselo; Mukuru, Moses; Kasasa, Simon
Policy implementation remains an under researched area in most low and middle income countries and it is not surprising that several policies are implemented without a systematic follow up of why and how they are working or failing. This study is part of a larger project called Supporting Policy Engagement for Evidence-based Decisions (SPEED) for Universal Health Coverage in Uganda. It seeks to support policymakers monitor the implementation of vital programmes for the realisation of policy goals for Universal Health Coverage. A Policy Implementation Barometer (PIB) is proposed as a mechanism to provide feedback to the decision makers about the implementation of a selected set of policy programmes at various implementation levels (macro, meso and micro level). The main objective is to establish the extent of implementation of malaria, family planning and emergency obstetric care policies in Uganda and use these results to support stakeholder engagements for corrective action. This is the first PIB survey of the three planned surveys and its specific objectives include: assessment of the perceived appropriateness of implementation programmes to the identified policy problems; determination of enablers and constraints to implementation of the policies; comparison of on-line and face-to-face administration of the PIB questionnaire among target respondents; and documentation of stakeholder responses to PIB findings with regard to corrective actions for implementation. Methods/Design: The PIB will be a descriptive and analytical study employing mixed methods in which both quantitative and qualitative data will be systematically collected and analysed. The first wave will focus on 10 districts and primary data will be collected through interviews. The study seeks to interview 570 respondents of which 120 will be selected at national level with 40 based on each of the three policy domains, 200 from 10 randomly selected districts, and 250 from 50 facilities. Half of the respondents at each level will be randomly assigned to either face-toface or on-line interviews. An integrated questionnaire for these interviews will collect both quantitative data through Likert scale-type questions, and qualitative data through open-ended questions. And finally focused dialogues will be conducted with selected stakeholders for feedback on the PIB findings. Secondary data will be collected using data extraction tools for performance statistics.
Cohort Profile: The Iganga-Mayuge Health and Demographic Surveillance Site, Uganda (IMHDSS, Uganda)
(International journal of epidemiology, 2020) Kajungu, Dan; Hirose, Atsumi; Rutebemberwa, Elizeus; Pariyo, George W; Peterson, Stefan; Guwatudde, David; Galiwango, Edward; Tusubira, Valerie; Kaija, Judith; Nareeba, Tryphena; Hanson, Claudia
The Iganga Mayuge Health and Demographic Surveillance Site (IMHDSS) was set up in 2004 to provide a platform for community-based epidemiological research and research training. Seed funding was provided by the Swedish International Development Agency (SIDA) as part of the Karolinska Institutet, Sweden and Makerere University– Sweden bilateral research collaboration. The specific objectives at inception were to (i) register and monitor health and demographic events (births, deaths, migration) and dynamics in a population and serve as a resource of information for decision making, providing an environment for several community-based projects in single-/multi-disciplinary research and research training; (ii) provide unique, essential, household-level information individually tailored for policy, planning and research needs; (iii) provide a platform for training in applied field research and practical health, socioeconomic and demographic survey methods to students, staff and researchers; and (iv) provide a platform for high-quality household survey data for operational field trials that measures interventions including but not limited to, monitoring trends in communicable and noncommunicable diseases (NCDs), clinical and vaccine trials and other surveillance activities.
Community Perceptions on Integrating Animal Vaccination and Health Education by Veterinary and Public Health Workers in the Prevention of Brucellosis among Pastoral Communities of South Western Uganda
(PLoS ONE, 2015) Kansiime, Catherine; Atuyambe, Lynn M.; Asiimwe, Benon B.; Mugisha, Anthony; Mugisha, Samuel; Guma, Victor; Rwego, Innocent B.; Rutebemberwa, Elizeus
Brucellosis is a zoonotic disease of veterinary, public health, and economic significance in most developing countries, yet there are few studies that show integrated human and veterinary health care intervention focusing on integration at both activity and actors levels. The aim of our study, therefore, was to explore community perceptions on integration of animal vaccination and health education by veterinary and public health workers in the management of brucellosis in Uganda. Methods This study used a qualitative design where six Focus Group Discussions (FGDs) that were homogenous in nature were conducted, two from each sub-county, one with the local leaders, and another with pastoralists and farmers. Five Key Informant Interviews (KIIs) with two public health workers and three veterinary extension workers from three sub-counties in Kiruhura district, Uganda were conducted. All FGDs were conducted in the local language and tape recorded with consent from the participants. KIIs were in English and later transcribed and analyzed using latent content data analysis method.
Consent for mobile phone surveys of non-communicable disease risk factors in low-resource settings: an exploratory qualitative study in Uganda
(Mhealth, 2019) Mwaka, Erisa; Nakigudde, Janet; Ali, Joseph; Ochieng, Joseph; Hallez, Kristina; Tweheyo, Raymond; Labrique, Alain; Gibson, Dustin G.; Rutebemberwa, Elizeus; Pariyo, George
Lack of data for timely decision-making around the prevention and control of noncommunicable diseases (NCDs) presents special challenges for policy makers, especially in resource-limited settings. New data collection methods, including pre-recorded Interactive Voice Response (IVR) phone surveys, are being developed to support rapid compilation of population-level disease risk factor information in such settings. We aimed to identify information that could be used to optimize consent approaches for future mobile phone surveys (MPS) employed in Uganda and, possibly, similar contexts. Methods: We conducted an in-depth qualitative study with key stakeholders in Uganda about consent approaches, and potential challenges, for pre-recorded IVR NCD risk factor surveys. Semi-structured interviews were conducted with 14 key informants. A contextualized thematic approach was used to interpret the results supported by representative quotes. Results: Several potential challenges in designing consent approaches for MPS were identified, including low literacy and the lack of appropriate ways of assessing comprehension and documenting consent. Communication with potential respondents prior to the MPS and providing options for callbacks were suggested as possible strategies for improving comprehension within the consent process. “Opt-in” forms of authorization were preferred over “opt-out”. There was particular concern about data security and confidentiality and how matters relating to this would be communicated to MPS respondents. Conclusions: These local insights provide important information to support optimization of consent for MPS, whose use is increasing globally to advance public health surveillance and research in constructive ways
Determinants of Patients’ Choice of Provider in Accessing Brucellosis Care among Pastoral Communities Adjacent to Lake Mburo National Park in Kiruhura District, Uganda
(PLoS ONE, 2014) Kansiime, Catherine; Rutebemberwa, Elizeus; Mugisha, Anthony; Mugisha, Samuel; Asiimwe, Benon B.; Rwego, Innocent B.; Kiwanuka, Suzanne N.
Brucellosis is the commonest zoonotic infection worldwide with symptoms similar to other febrile syndromes such as malaria and typhoid fever. It is often easily misdiagnosed, resulting in underreporting and misdirected treatments. Understanding of the factors that influence brucellosis care seeking is essential in enhancing its effective management. Our study sought to determine the factors associated with choice of provider in accessing care for brucellosis among pastoral communities in Uganda. Methods: This was a cross-sectional survey involving 245 randomly selected respondents previously diagnosed and treated for brucellosis, two months before the study. They were enrolled from three sub-counties neighboring Lake Mburo National Park between December 2012 to April 2013. Data on socio-demographics, availability, accessibility, affordability and acceptability of health services were collected. A multivariable logistic regression model was fitted to determine association between independent and outcome variables using odds ratios and 95% confidence intervals with p-value#0.05 considered statistically significant. Results: Of the 245 respondents, 127(51.8%) sought health care at government facilities and the rest at private. Respondents who were less likely to choose a government facility were either single (OR: 0.50, CI: 0.26–0.97), had general weakness (OR: 0.09, CI: 0.01–0.72) or whom family took a decision (OR: 0.52, CI: 0.28–0.97). At multivariable analysis, choice of government facility was influenced by primary education (aOR: 0.46, CI: 0.22–0.97), having six to ten household members (aOR:3.71, CI:1.84–7.49), family advice (aOR:0.64, CI: 0.23–0.91), distance $10 kms (aOR:0.44, CI: 0.21–0.92), high costs at private clinics (aOR:0.01, CI:0.02–0.15) and no diagnosis at government facility (aOR:0.11, CI:0.01–0.97). Females were more likely to seek health care at government facilities, while those with tertiary education were less likely, after the first provider. Conclusions: Females and households with six to ten members were more likely to choose government facilities. Government facilities need to be equipped to attract more patients.
Evaluation of a health systems knowledge translation network for Africa (KTNET): a study protocol
(Implementation Science, 2014) Ekirapa-Kiracho, Elizabeth; Walugembe, David R.; Tetui, Moses; Kisakye, Angela N.; Rutebemberwa, Elizeus; Sengooba, Freddie; Kananura, Rornald M.; Wensin, Michel; Kiwanuka, Suzanne N.
Despite the increasing investment in health-related research in Sub-Saharan Africa, a large gulf remains between what is known and what is practiced in health systems. Knowledge translation programs aim to ensure that a wide range of stakeholders are aware of and use research evidence to inform their health and health-care decision-making. The purpose of this study is to provide insight into the impacts on capacity building for knowledge translation and knowledge translation activities by a coalition of eight research groups in Africa. Methods/design: We will use a mixed methods approach. Key informant interviews and document reviews will be employed to evaluate changes in knowledge translation capacity and to evaluate the effects of knowledge translation on potential users of research. Quarterly teleconferences will be done to evaluate the impacts of knowledge translation activities on users of research. Using website tracking, we will be able to explore the influence of knowledge translation networking and dynamics of the knowledge translation network. Discussion: We have adopted the dynamic knowledge transfer model and the Landry framework to come up with a framework for this study so as to explore the capacity of producers and users of research to generate, disseminate, and use research findings, while highlighting their strengths and weaknesses. This information will be useful for guiding implementers that seek to build capacity on knowledge translation so as to promote the utilization of research findings for informing programs, practice, and policy.
Evidence summaries tailored to health policy-makers in low- and middle-income countries
(Bulletin of the World Health Organization, 2011) Rosenbaum, Sarah E.; Glenton, Claire; Wiysonge, Charles Shey; Abalos, Edgardo; Mignini, Luciano; Young, Taryn; Althabe, Fernando; Ciapponi, Agustín; Garcia Marti, Sebastian; Meng, Qingyue; Wang, Jian; Bradford, Ana Maria De la Hoz; Kiwanuka, Suzanne N.; Rutebemberwa, Elizeus; Pariyo, George W.; Flottorp, Signe; Oxman, Andrew D.
To describe how the SUPPORT collaboration developed a short summary format for presenting the results of systematic reviews to policy-makers in low- and middle-income countries (LMICs). Methods We carried out 21 user tests in six countries to explore users’ experiences with the summary format. We modified the summaries based on the results and checked our conclusions through 13 follow-up interviews. To solve the problems uncovered by the user testing, we also obtained advisory group feedback and conducted working group workshops. Findings Policy-makers liked a graded entry format (i.e. short summary with key messages up front). They particularly valued the section on the relevance of the summaries for LMICs, which compensated for the lack of locally-relevant detail in the original review. Some struggled to understand the text and numbers. Three issues made redesigning the summaries particularly challenging: (i) participants had a poor understanding of what a systematic review was; (ii) they expected information not found in the systematic reviews and (iii) they wanted shorter, clearer summaries. Solutions included adding information to help understand the nature of a systematic review, adding more references and making the content clearer and the document quicker to scan. Conclusion Presenting evidence from systematic reviews to policy-makers in LMICs in the form of short summaries can render the information easier to assimilate and more useful, but summaries must be clear and easy to read or scan quickly. They should also explain the nature of the information provided by systematic reviews and its relevance for policy decisions.
Health sector reforms and human resources for health in Uganda and Bangladesh: mechanisms of effect
(Human resources for health, 2007) Ssengooba, Freddie; Rahman, Syed A.; Hongoro, Charles; Rutebemberwa, Elizeus; Mustafa, Ahmed; Kielmann, Tara; McPake, Barbara
Despite the expanding literature on how reforms may affect health workers and which reactions they may provoke, little research has been conducted on the mechanisms of effect through which health sector reforms either promote or discourage health worker performance. This paper seeks to trace these mechanisms and examines the contextual framework of reform objectives in Uganda and Bangladesh, and health workers' responses to the changes in their working environments by taking a 'realistic evaluation' approach. Methods: The study findings were generated by triangulating both qualitative and quantitative methods of data collection and analysis among policy technocrats, health managers and groups of health providers. Quantitative surveys were conducted with over 700 individual health workers in both Bangladesh and Uganda and supplemented with qualitative data obtained from focus group discussions and key interviews with professional cadres, health managers and key institutions involved in the design, implementation and evaluation of the reforms of interest. Results: The reforms in both countries affected the workforce through various mechanisms. In Bangladesh, the effects of the unification efforts resulted in a power struggle and general mistrust between the two former workforce tracts, family planning and health. However positive effects of the reforms were felt regarding the changes in payment schemes. Ugandan findings show how the workforce responded to a strong and rapidly implemented system of decentralisation where the power of new local authorities was influenced by resource constraints and nepotism in recruitment. On the other hand, closer ties to local authorities provided the opportunity to gain insight into the operational constraints originating from higher levels that health staff were dealing with.
High Adherence to Antimalarials and Antibiotics under Integrated Community Case Management of Illness in Children Less than Five Years in Eastern Uganda
(PLoS ONE, 2013) Kalyango, Joan N.; Rutebemberwa, Elizeus; Karamagi, Charles; Mworozi, Edison; Ssali, Sarah; Alfven, Tobias; Peterson, Stefan
Development of resistance to first line antimalarials led to recommendation of artemisinin based combination therapies (ACTs). High adherence to ACTs provided by community health workers (CHWs) gave reassurance that community based interventions did not increase the risk of drug resistance. Integrated community case management of illnesses (ICCM) is now recommended through which children will access both antibiotics and antimalarials from CHWs. Increased number of medicines has been shown to lower adherence.
Increased Use of Community Medicine Distributors and Rational Use of Drugs in Children Less than Five Years of Age in Uganda Caused by Integrated Community Case Management of Fever
(The American journal of tropical medicine and hygiene, 2012) Kalyango, Joan N.; Lindstrand, Ann; Rutebemberwa, Elizeus; Ssali, Sarah; Kadobera, Daniel; Karamagi, Charles; Peterson, Stefan; Alfven, Tobias
We compared use of community medicine distributors (CMDs) and drug use under integrated community case management and home-based management strategies in children 6–59 months of age in eastern Uganda. A crosssectional study with 1,095 children was nested in a cluster randomized trial with integrated community case management (CMDs treating malaria and pneumonia) as the intervention and home-based management (CMDs treating only malaria) as the control. Care-seeking from CMDs was higher in intervention areas (31%) than in control areas (22%; P = 0.01). Prompt and appropriate treatment of malaria was higher in intervention areas (18%) than in control areas (12%; P = 0.03) and among CMD users (37%) than other health providers (9%). The mean number of drugs among CMD users compared with other health providers was 1.6 versus 2.4 in intervention areas and 1.4 versus 2.3 in control areas. Use of CMDs was low. However, integrated community case management of childhood illnesses increased use of CMDs and rational drug use.
Integrated community case management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms in children under five years in Eastern Uganda
(Malaria Journal, 2013) Kalyango, Joan N.; Alfven, Tobias; Peterson, Stefan; Mugenyi, Kevin; Karamagi, Charles; Rutebemberwa, Elizeus
Efforts to improve access to treatment for common illnesses in children less than five years initially targeted malaria alone under the home management of malaria strategy. However under this strategy, children with other illnesses were often wrongly treated with anti-malarials. Integrated community case management of common childhood illnesses is now recommended but its effect on promptness of appropriate pneumonia treatment is unclear. Objectives: To determine the effect of integrated malaria and pneumonia management on receiving prompt and appropriate antibiotics for pneumonia symptoms and treatment outcomes as well as determine associated factors. Methods: A follow-up study was nested within a cluster-randomized trial that compared under-five mortality in areas where community health workers (CHWs) treated children with malaria and pneumonia (intervention areas) and where they treated children with malaria only (control areas). Children treated by CHWs were enrolled on the day of seeking treatment from CHWs (609 intervention, 667 control) and demographic, illness, and treatment seeking information was collected. Further information on illness and treatment outcomes was collected on day four. The primary outcome was prompt and appropriate antibiotics for pneumonia symptoms and the secondary outcome was treatment outcomes on day four. Results: Children in the intervention areas were more likely to receive prompt and appropriate antibiotics for pneumonia symptoms compared to children in the control areas (RR = 3.51, 95%CI = 1.75-7.03). Children in the intervention areas were also less likely to have temperature ≥37.5°C on day four (RR = 0.29, 95%CI = 0.11-0.78). The decrease in fast breathing between day one and four was greater in the intervention (9.2%) compared to the control areas (4.2%, p-value = 0.01). Conclusions: Integrated community management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms and improves treatment outcomes.
Knowledge and perceptions of brucellosis in the pastoral communities adjacent to Lake Mburo National Park, Uganda
(BMC Public Health, 2014) Kansiime, Catherine; Mugisha, Anthony; Makumbi, Fredrick; Mugisha, Samuel; Rwego, Innocent B.; Sempa, Joseph; Kiwanuka, Suzanne N.; Asiimwe, Benon B.; Rutebemberwa, Elizeus
Brucellosis is one of the most common zoonotic infections globally. Lack of knowledge about brucellosis may affect the health-seeking behavior of patients, thus leading to sustained transmission in these communities. Our study assessed knowledge and perceptions of brucellosis among pastoral communities adjacent to Lake Mburo National Park (LMNP), Kiruhura District, Uganda. Methods: A community cross-sectional questionnaire survey involving 371 randomly selected household heads from three sub-counties neighboring LMNP were interviewed between June and August 2012. Data collected included communities’ knowledge on causes, symptoms, transmission, treatment, prevention and risk factors of brucellosis. Multivariable logistic regression analysis was performed to explore strength of association between overall knowledge of brucellosis and various individual factors using odds ratios and 95% confidence intervals. Results: Only 70 (19%) knew the symptoms of brucellosis in animals, and three quarters (279, 75.5%) mentioned joint and muscle pain as a common symptom in humans. Almost all participants (370, 99.3%) had ever heard about brucellosis, majority (311, 84.7%) believed it affects all sexes and two thirds (67.7%) of the respondents believed close proximity to wildlife contributes to the presence of the disease. Almost all (352, 95.4%) knew that brucellosis in humans could be treatable using modern drugs. The main routes of infection in humans such as consumption of unpasteurized dairy products were known by 97% (360/371); eating of half-cooked meat by 91.4% and eating contaminated pasture in animals by 97.4%. There was moderate overall knowledge of brucellosis 197 (53.1%). Factors associated with higher overall knowledge were being agro-pastoralists (aOR: 2.08, CI: 1.17-3.71) compared to pure pastoralists while those who reported that the disease was a health problem (aOR: 0.18, CI: 0.06-0.56) compared to those who said it was not were less likely to be knowledgeable. Conclusions: There was moderate overall knowledge of human and animal brucellosis among the participants. Majority of the participants believed that close proximity to wildlife contributes to the presence of the disease in the area. There is a need for collaboration between the public health, veterinary and wildlife sectors to provide health education on brucellosis for better management of the disease in the communities.
Modifiable Socio-Behavioural Factors Associated with Overweight and Hypertension among Persons Aged 35 to 60 Years in Eastern Uganda
(PLoS ONE, 2012) Mayega, Roy William; Makumbi, Fredrick; Rutebemberwa, Elizeus; Peterson, Stefan; O¨stenson, Claes- Goran; Tomson, Goran; Guwatudde, David
Few studies have examined the behavioural correlates of non-communicable, chronic disease risk in lowincome countries. The objective of this study was to identify socio-behavioural characteristics associated with being overweight or being hypertensive in a low-income setting, so as to highlight possible interventions and target groups. Methods: A population based survey was conducted in a Health and Demographic Surveillance Site (HDSS) in eastern Uganda. 1656 individuals aged 35 to 60 years had their Body Mass Index (BMI) and blood pressure (BP) assessed. Seven lifestyle factors were also assessed, using a validated questionnaire. Logistic regression was used to identify sociobehavioural factors associated with being overweight or being hypertensive. Results: Prevalence of overweight was found to be 18% (25.2% of women; 9.7% of men; p,0.001) while prevalence of obesity was 5.3% (8.3% of women; 2.2% of men). The prevalence of hypertension was 20.5%. Factors associated with being overweight included being female (OR 3.7; 95% CI 2.69–5.08), peri-urban residence (OR 2.5; 95% CI 1.46–3.01), higher socioeconomic status (OR 4.1; 95% CI 2.40–6.98), and increasing age (OR 1.8; 95% CI 1.12–2.79). Those who met the recommended minimum physical activity level, and those with moderate dietary diversity were less likely to be overweight (OR 0.5; 95% CI 0.35–0.65 and OR 0.7; 95% CI 0.49–3.01). Factors associated with being hypertensive included peri-urban residence (OR 2.4; 95%CI 1.60–3.66), increasing age (OR 4.5; 95% CI 2.94–6.96) and being over-weight (OR 2.8; 95% CI 1.98– 3.98). Overweight persons in rural areas were significantly more likely to be hypertensive than those in peri-urban areas (p = 0.013). Conclusions: Being overweight in low-income settings is associated with sex, physical activity and dietary diversity and being hypertensive is associated with being overweight; these factors are modifiable. There is need for context-specific health education addressing disparities in lifestyles at community levels in rural Africa.
Performance of community health workers under integrated community case management of childhood illnesses in eastern Uganda
(Malaria Journal, 2012) Kalyango, Joan N.; Rutebemberwa, Elizeus; Alfven, Tobias; Ssali, Sarah; Peterson, Stefan; Karamagi, Charles
Curative interventions delivered by community health workers (CHWs) were introduced to increase access to health services for children less than five years and have previously targeted single illnesses. However, CHWs in the integrated community case management of childhood illnesses strategy adopted in Uganda in 2010 will manage multiple illnesses. There is little documentation about the performance of CHWs in the management of multiple illnesses. This study compared the performance of CHWs managing malaria and pneumonia with performance of CHWs managing malaria alone in eastern Uganda and the factors influencing performance.
Policy Challenges Facing the Scale Up of Integrated Community Case Management (iCCM) in Uganda
(International Journal of Health Policy and Management, 2021) Awor, Phyllis; Nakayaga Kalyango, Joan; Stålsby Lundborg, Cecilia; Ssengooba, Freddie; Eriksen, Jaran; Rutebemberwa, Elizeus
Integrated Community Case Management (iCCM) of malaria, pneumonia and diarrhoea is an equity focused strategy, to increase access to care for febrile illness in children under-5 years of age, in rural communities. Lay community members are trained to diagnose and treat malaria, pneumonia and diarrhoea in children, and to identify and refer very ill children. Today, many low-income countries including Uganda, have a policy for iCCM which is being rolled out through public sector community health workers (CHWs). Ten years after the introduction of the iCCM strategy in Uganda, it is important to take stock and understand the barriers and facilitators affecting implementation of the iCCM policy. Methods: We conducted an iCCM policy analysis in order to identify the challenges, enablers and priorities for scale-up of the iCCM strategy in Uganda. This was a qualitative case study research which included a document review (n = 52) and key informant interviews (n = 15) with Ugandan stakeholders. Interviews were conducted in 2017 and the desk review included literature up to 2019. Results: This paper highlights the iCCM policy trajectory since 2010 in Uganda and includes a policy timeline. The iCCM policy process was mainly led by international agencies from inception, with little ownership of the government. Many implementation challenges including low government funding, weak coordination and contradicting policies were identified, which could contribute to the slow scale up of the iCCM program. Despite the challenges, many enablers and opportunities also exist within the health system, which should be further harnessed to scale up iCCM in Uganda. These enabling factors include strong community commitment, existing policy instruments and the potential of utilizing also the private sector for iCCM implementation. Conclusion: The iCCM program in Uganda needs to be strengthen through increased domestic funding, strong coordination and a focus on monitoring, evaluation and operational research.
Regulatory mechanisms for absenteeism in the health sector: a systematic review of strategies and their implementation
(Journal of healthcare leadership, 2016) Kisakye, Angela N.; Tweheyo, Raymond; Ssengooba, Freddie; Pariyo, George W.; Rutebemberwa, Elizeus; Kiwanuka, Suzanne N.
A systematic review was undertaken to identify regulatory mechanisms aimed at mitigating health care worker absenteeism, to describe where and how they have been implemented as well as their possible effects. The goal was to propose potential policy options for managing the problem of absenteeism among human resources for health in low- and middleincome countries. Mechanisms described in this review are at the local workplace and broader national policy level. Methods: A comprehensive online search was conducted on EMBASE, CINAHL, PubMed, Google Scholar, Google, and Social Science Citation Index using MEDLINE search terms. Retrieved studies were uploaded onto reference manager and screened by two independent reviewers. Only publications in English were included. Data were extracted and synthesized according to the objectives of the review. Results: Twenty six of the 4,975 published articles retrieved were included. All were from highincome countries and covered all cadres of health workers. The regulatory mechanisms and possible effects include 1) organizational-level mechanisms being reported as effective in curbing absenteeism in low- and middle-income countries (LMICs); 2) prohibition of private sector activities in LMICs offering benefits but presenting a challenge for the government to monitor the health workforce; 3) contractual changes from temporary to fixed posts having been associated with no reduction in absenteeism and not being appropriate for LMICs; 4) multifaceted work interventions being implemented in most settings; 5) the possibility of using financial and incentive regulatory mechanisms in LMICs; 6) health intervention mechanisms reducing absenteeism when integrated with exercise programs; and 7) attendance by legislation during emergencies being criticized for violating human rights in the United States and not being effective in curbing absenteeism. Conclusion: Most countries have applied multiple strategies to mitigate health care worker absenteeism. The success of these interventions is heavily influenced by the context within which they are applied.
Research for universal health coverage: setting priorities for policy and systems research in Uganda
(Global Health Action, 2021) Ssengooba, Freddie; Ssennyonjo, Aloysius; Rutebemberwa, Elizeus; Musila, Timothy; Namusoke Kiwanuka, Suzanne; Kemari, Enid; Nattimba, Milly
There is international consensus on the need for countries to work towards achieving universal health coverage (UHC) whereby the population is given access to all appropriate promotive, preventive, curative and rehabilitative services at affordable cost. The World Health Organisation (2013) urges all countries to undertake research to customise UHC within national development agendas. Objective: To describe the process used to prioritise UHC within the health systems research and development agenda in Uganda. Methods: Two national consultative workshops were convened in May and August 2015 to develop a UHC research agenda in Uganda. The participants included multisector representatives from local, national, and international organisations. A participatory approach with structured deliberations and multi-voting techniques was used. Stakeholders’ views were analysed thematically according to health systems building blocks, and multi-voting was used to assign priorities across themes and sub-themes. The priorities were further validated and disseminated at national health sector meetings. Results: Of the 80 invited stakeholders, 57 (71.3%) attended. The expressed priorities were: 1) health workforce; 2) governance; 3) financing; 4) service delivery, and 5) community health. The participants also recommended crosscutting research themes to address the social determinants of health, multisectoral collaboration, and health system resilience to protect against external shocks and disease epidemics. Conclusion: Discussions that capture the diverse perspectives of stakeholders provide a way of exploring UHC within health policy and systems development. In Uganda, attention should be paid to the principal challenges of mobilising financial and technical capabilities for research and strengthening the link between evidence generation and policy actions to achieve UHC.
Species And Drug Susceptibility Profiles Of Staphylococci Isolated From Healthy Children In Eastern Uganda
(PloS one, 2020) Kateete, David Patrick; Asiimwe, Benon B.; Mayanja, Raymond; Najjuka, Christine Florence; Rutebemberwa, Elizeus
Staphylococci are a key component of the human microbiota, and they mainly colonize the skin and anterior nares. However, they can cause infection in hospitalized patients and healthy individuals in the community. Although majority of the Staphylococcus aureus strains are coagulase-positive, some do not produce coagulase, and the isolation of coagulase-positive non-S. aureus isolates in humans is increasingly being reported. Therefore, sound knowledge of the species and characteristics of staphylococci in a given setting is important, especially isolates from children and immunocompromised individuals. The spectrum of Staphylococcus species colonizing children in Uganda is poorly understood; here, we aimed to determine the species and characteristics of staphylococci isolated from children in Eastern Uganda. Seven hundred and sixty four healthy children less than 5 years residing in Iganga and Mayuge districts in Eastern Uganda were enrolled. A total of 513 staphylococci belonging to 13 species were isolated from 485 children (63.5%, 485/764), with S. aureus being the dominant species (37.6%, 193/513) followed by S. epidermidis (25.5%, 131/513), S. haemolyticus (2.3%, 12/513), S. hominis (0.8%, 4/513) and S. haemolyticus/lugdunensis (0.58%, 3/513). Twenty four (4.95%, 24/485) children were co-colonized by two or more Staphylococcus species. With the exception of penicillin, antimicrobial resistance (AMR) rates were low; all isolates were susceptible to vancomycin, teicoplanin, linezolid and daptomycin. The prevalence of methicillin resistance was 23.8% (122/513) and it was highest in S. haemolyticus (66.7%, 8/12) followed by S. aureus (28.5%, 55/193) and S. epidermidis (23.7%, 31/131). The prevalence of multidrug resistance was 20.3% (104/513), and 59% (72/122) of methicillin resistant staphylococci were multidrug resistant. Four methicillin susceptible S. aureus isolates and a methicillin resistant S. scuiri isolate were mupirocin resistant (high-level). The most frequent AMR genes were mecA, vanA, ant(4')-Ia, and aac(6')-Ie- aph(2'')-Ia, pointing to presence of AMR drivers in the community.
Understanding the dynamic interactions driving the sustainability of ART scale-up implementation in Uganda
(Global health research and policy, 2018) Zakumumpa, Henry; Dube, Nkosiyazi; Shumbusho Damian, Respicius; Rutebemberwa, Elizeus
Despite increasing recognition that health-systems constraints are the fundamental barrier to attaining anti-retroviral therapy (ART) scale-up targets in Sub-Saharan Africa, current discourses are dominated by a focus on financial sustainability. Utilizing the health system dynamics framework, this study aimed to explore the interactions in health system components and their influence on the sustainability of ART scale-up implementation in Uganda. Methods: This study entailed qualitative organizational case-studies within a two-phased mixed-methods sequential explanatory research design. In Phase One, a survey of 195 health facilities across Uganda which commenced ART services between 2004 and 2009 was conducted. In Phase Two, six health facilities were purposively selected for in-depth examination involving i) In-depth interviews (n = 44) ii) and semistructured interviews (n = 35). Qualitative data was analyzed by coding and thematic analysis. Descriptive statistics were managed in STATA (v 13). Results: Five dynamic interactions in ART program sustainability drivers were identified; i) Failure to update basic ART program records contributed to chronic ART medicines stock-outs ii) Health workforce shortages and escalating patient volumes prompted adaptations in ART service delivery models iii) Broader governance issues manifested in poor road networks undermined ART medicines supply chains iv) Sustained financing for ART programs was influenced by external donors v) The values associated with the ownership-type of a health facility affected ART service delivery and coverage. Conclusion: The sustainability of ART programs at the facility-level in Uganda is a function of a complex interaction in elements of the health system and must be understood beyond sustaining international funding for ART scale-up.
Use of Community Health Workers for Management of Malaria and Pneumonia in Urban and Rural Areas in Eastern Uganda
(The American Journal of Tropical Medicine and Hygiene,, 2012) Rutebemberwa, Elizeus; Kadobera, Daniel; Katureebe, Sheila; Kalyango, Joan N.; Mworozi, Edison; Pariyo, George
Use of community health workers (CHWs) has been implemented the same way in urban and rural areas despite differences in availability of health providers and sociodemographic characteristics. A household survey was conducted in rural and urban areas in eastern Uganda, and all children who were febrile in the previous two weeks were assessed for their symptoms, treatment received at home, and when and where they first went for treatment. Rural children were more likely to use CHWs than urban children. Urban children received outside treatment more promptly, and used herbs at home less. Symptoms and proportion of children being taken out for treatment were similar. Children from the poorest households used CHWs less and private providers more than the middle quintiles. Drug shops and private clinics should be included in the community case management to cater for the poorest in rural areas and persons in urban areas.

Browsing by Author "Rutebemberwa, Elizeus"

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