Browsing by Author "Ssempala, Richard"
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Item 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 KObjectiveIn 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.Item Health Sector Budgetary Allocations and their Implications On Health Service Delivery and UHC in Uganda(SPEED Initiative, 2019) Ssempala, Richard; Kintu, Francis; Okuda, Boniface; Ssengooba, Freddie; Bagonza, John; Tashobya, Christine K.The health of Ugandans has improved over the last 2 decades as shown by various indicators1. Infant mortality rate declined from 94 to 43 deaths per 1,000 live births over the same period (1998-2018) while under-five mortality rate reduced from 149 to 64 deaths per 1,000 live births2. There has also been a reduction in maternal deaths with the maternal mortality ratio declining from 639 deaths per 100,000 live births in 1998 to 336 in 20163.The average number of children born by a Ugandan woman in her life time (fertility rate) declined from 6.9 in 1999 to 5.5 in 20164. However, people’s health is still poor as shown by the fact that the country is ranked 186 out of 191 WHO member states. Life expectancy at birth for Ugandans is still low estimated at 62.5 years. The common causes of illness include malaria and pneumonia (cough or cold) –contributing more than 50% of the OPD attendances. The number of malaria cases per 1,000 persons stood at 433 in 2016/175. HIV/AIDS prevalence among adults aged 15 to 64 is estimated at 6.2% -This corresponds to approximately 1.2 million people living with HIV. In addition there is increasing prevalence of non-communicable diseases like diabetes hypertension and cancer.Item Strategic Purchasing Arrangements in Uganda and Their Implications for Universal Health Coverage(Health Systems & Reform, 2022) Ekirapa-Kiracho, Elizabeth; Ssennyonjo, Aloysius; Cashin, Cheryl; Gatome-Munyua, Agnes; Olalere, Nkechi; Ssempala, Richard; Mayora, Chrispus; Ssengooba, FreddieSeveral purchasing arrangements coexist in Uganda, creating opportunities for synergy but also leading to conflicting incentives and inefficiencies in resource allocation and purchasing functions. This paper analyzes the key health care purchasing functions in Uganda and the implications of the various purchasing arrangements for universal health coverage (UHC). The data for this paper were collected through a document review and stakeholder dialogue. The analysis was guided by the Strategic Health Purchasing Progress Tracking Framework created by the Strategic Purchasing Africa Resource Center (SPARC) and its technical partners. Uganda has a minimum health care package that targets the main causes of morbidity and mortality as well as specific vulnerable groups. However, provision of the package is patchy, largely due to inadequate domestic financing and duplication of services funded by development partners. There is selective contracting with private-sector providers. Facilities receive direct funding from both the government budget and development partners. Unlike government-budget funding, payment from output-based donor-funded projects and performance-based financing (PBF) projects is linked to service quality and has specified conditions for use. Specification of UHC targets is still nascent and evolving in Uganda. Expansion of service coverage in Uganda can be achieved through enhanced resource pooling and harmonization of government and donor priorities. Greater provider autonomy, better work planning, direct facility funding, and provision of flexible funds to service providers are essential elements in the delivery of high-quality services that meet local needs and Uganda’s UHC aspirations.