Browsing by Author "Ssebagereka, Anthony"

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    Costs and resource distribution of direct services for HIV in Uganda
    (British Medical Journal Publishing Group, 2024-10) Ekirapa, Elizabeth; Jordan, Monica; Nong, Thuong; Marton, Tozoe Elaine; Balidawa, Hudson; Ssempala, Richard; Ssebagereka, Anthony; Kagaayi, Joseph; Nandakumar, Allyala; McBain, Ryan K
    ObjectiveIn high HIV-burden countries like Uganda, financing and resource allocation for HIV services have rapidly evolved. This study aimed to employ time-driven activity-based costing (TDABC) to examine the allocation of resources and associated costs for HIV care throughout the country.DesignA cross-sectional study.SettingThis study was conducted at 31 health facilities throughout Uganda: 16 level III health centres, 10 level IV health centres and 5 district hospitals.Participants1119 persons receiving HIV services in 2020.MethodsWe conducted TDABC to quantify costs, resource consumption and duration of service provision associated with antiretroviral therapy, prevention of mother-to-child transmission, HIV counselling and testing (HCT), voluntary medical male circumcision (VMMC) and pre-exposure prophylaxis. We also quantified disparities in resource consumption according to client-level and facility-level characteristics to examine equity. Fixed-effects multivariable regression analyses were employed to inspect factors associated with service costs and provider-client interaction time.ResultsThe mean cost of services ranged from US$8.18 per visit for HCT to US$32.28 for VMMC. In terms of disparities, those in the Western region received more provider time during visits compared with other regions (35 more minutes, p<0.001); and those receiving care at private facilities received more provider time compared with public facilities (13 more minutes, p=0.02); and those at level IV health centres received more time compared with those at level III (12 more minutes, p=0.01). Absent consumables, services for older adults (US$2.28 higher, p=0.02), those with comorbidities (US$1.44 higher, p<0.001) and those living in the Western region (US$2.88 higher, p<0.001) were more expensive compared with younger adults, those without comorbidities and those in other regions, respectively. Inclusive of consumables, services were higher-cost for individuals in wealthier households (US$0.83 higher, p=0.03) and those visiting level IV health centres (US$3.41 higher, p=0.006) compared with level III.ConclusionsCosts and resources for HIV care vary widely throughout Uganda. This variation requires careful consideration: some sources of variation may be indicative of vertical and horizontal equity within the health system, while others may be suggestive of inequities.
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    Effect of four or more antenatal care visits on facility delivery and early postnatal care services utilization in Uganda: a propensity score matched analysis
    (BMC pregnancy and childbirth, 2022) Mwebesa, Edson; Kagaayi, Joseph; Ssebagereka, Anthony; Nakafeero, Mary; Ssenkusu, John M.; Guwatudde, David; Mbona Tumwesigye, Nazarius
    Maternal mortality remains a global public health issue, more predominantly in developing countries, and is associated with poor maternal health services utilization. Antenatal care (ANC) visits are positively associated with facility delivery and postnatal care (PNC) utilization. However, ANC in itself may not lead to such association but due to differences that exist among users (women). The purpose of this study, therefore, is to examine the effect of four or more ANC visits on facility delivery and early PNC and also the effect of facility-based delivery on early PNC using Propensity Score Matched Analysis (PSMA). Methods: The present study utilized the 2016 Uganda Demographic and Health Survey (UDHS) dataset. Women aged 15 – 49 years who had given birth three years preceding the survey were considered for this study. Propensity score-matched analysis was used to analyze the effect of four or more ANC visits on facility delivery and early PNC and also the effect of facility-based delivery on early PNC. Results: The results revealed a significant and positive effect of four or more ANC visits on facility delivery [ATT (Average Treatment Effect of the Treated)=0.118, 95% CI: 0.063 – 0.173] and early PNC [ATT=0.099, 95% CI: 0.076 – 0.121]. It also found a positive and significant effect of facility-based delivery on early PNC [ATT=0.518, 95% CI: 0.489 – 0.547]. Conclusion: Policies geared towards the provision of four or more ANC visits are an effective intervention towards improved facility-based delivery and early PNC utilisation in Uganda.