The Challenge to Restoring Basic Health Care in Uganda
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Date
1998
Journal Title
Journal ISSN
Volume Title
Publisher
Social Science & Medicine
Abstract
This paper presents the results of a health facility survey conducted in Uganda between June
1992 and December 1993. The survey covered both government and non-government organisation
(NGO) facilities from 10 districts in the five regions of the country. The main objective of the survey
was to assess resource use, costs and financing of health facilities. The survey found differences between
resource levels of NGOs and government facilities. Government facilities were inadequately maintained,
and mostly in a state of disrepair. The user fee scheme that had been recently introduced in some government
units to meet running costs was not only inadequate, but was not being used to meet the
needs of consumers. In addition, most available resources, including human resources, were concentrated
in hospitals. As a result, there was heavy demand for hospital services and less use of services in
the lower level facilities. And furthermore, staff in government facilities were paid much less than staff
working for NGOs, who not only got better pay but also in-kind forms of rewards, which made them
better motivated to work. The number of qualified staff, particularly for primary health care, was
grossly inadequate, and most of the work in local facilities was being done by unqualified employees,
such as ward maids and dressers. In order to alleviate some of the problems identified, particularly in
government facilities, there is a need to explore ways in which more can be done with the available
resources to improve the efficiency of health services. The user charge system could be effective in
improving the resource base of the health facilities, but it must result in visible improvement in the quality
of services for consumers to be willing to pay. Collection methods should be standardized, and
expenditures supervised. As part of the government's decentralization programme, districts should be
given the power to recruit and fire personnel. Once this authority is in place, the district should consider
employing fewer personnel at all levels and aim to pay them a living wage.
Description
Keywords
Challenge, Restoring Basic Health Care, Uganda
Citation
Okello, D. O., Lubanga, R., Guwatudde, D., & Sebina-Zziwa, A. (1998). The challenge to restoring basic health care in Uganda. Social Science & Medicine, 46(1), 13-21.