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Baayenda G, Mugume F, Mubangizi A, Turyaguma P, Tukahebwa EM, Byakika S, Kahwa B, Kusasira D, Bakhtiari A, Boyd S, Butcher R, Solomon AW, Binagwa B, Agunyo S, Osilo M, Crowley K, Thuo W, French M, Plunkett E, Mosher AW, Harding-Esch EM, Ngondi J. Baseline Prevalence of Trachoma in Refugee Settlements in Uganda: Results of 11 Population-based Surveys. Ophthalmic Epidemiol 2023; 30:580-590. [PMID: 34488539 PMCID: PMC10581675 DOI: 10.1080/09286586.2021.1961816] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/29/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE There are several settlements in the Northern and Western Regions of Uganda serving refugees from South Sudan and Democratic Republic of Congo (DRC), respectively. Trachoma prevalence surveys were conducted in a number of those settlements with the aim of determining whether interventions for trachoma are required. METHODS An evaluation unit (EU) was defined as all refugee settlements in one district. Cross-sectional population-based trachoma prevalence survey methodologies designed to adhere to World Health Organization recommendations were deployed in 11 EUs to assess prevalence of trachomatous inflammation-follicular (TF) in 1-9-year-olds and trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds. Household-level water, sanitation and hygiene coverage was also assessed in study populations. RESULTS A total of 40,892 people were examined across 11 EUs between 2018 and 2020. The prevalence of TF in 1-9-year-olds was <5% in all EUs surveyed. The prevalence of trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds was <0.2% in 5 out of 11 EUs surveyed and ≥0.2% in the remaining 6 EUs. A high proportion of households had improved water sources, but a low proportion had improved latrines or quickly (within a 30-minute return journey) accessible water sources. CONCLUSIONS Implementation of the antibiotic, facial cleanliness and environmental improvement components of the SAFE strategy is not needed for the purposes of trachoma's elimination as a public health problem in these refugee settlements; however, intervention with TT surgery is needed in six EUs. Since instability continues to drive displacement of people from South Sudan and DRC into Uganda, there is likely to be a high rate of new arrivals to the settlements over the coming years. These populations may therefore have trachoma surveillance needs that are distinct from the surrounding non-refugee communities.
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Affiliation(s)
| | | | | | | | | | | | - Binta Kahwa
- Kampala International University Medical School, Kampala, Uganda
| | - Darlson Kusasira
- Refugees Department, Office of the Prime Minister, Kampala, Uganda
| | | | - Sarah Boyd
- Task Force for Global Health, Atlanta, Georgia, USA
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | | | | | | | | | | | | | | - Aryc W. Mosher
- United States Agency for International Development, Washington DC, USA
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Mayora C, Kazibwe J, Ssempala R, Nakimuli B, Ssennyonjo A, Ekirapa E, Byakika S, Aliti T, Musila T, Gad M, Vassall A, Ruiz F, Ssengooba F. Health technology assessment (HTA) readiness in Uganda: stakeholder's perceptions on the potential application of HTA to support national universal health coverage efforts. Int J Technol Assess Health Care 2023; 39:e65. [PMID: 37905441 DOI: 10.1017/s0266462323002635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Health technology assessment (HTA) is an area that remains less implemented in low- and lower middle-income countries. The aim of the study is to understand the perceptions of stakeholders in Uganda toward HTA and its role in decision making, in order to inform its potential implementation in the country. METHODS The study takes a cross-sectional mixed methods approach, utilizing an adapted version of the International Decision Support Initiative questionnaire with both semi-structured and open-ended questions. We interviewed thirty key informants from different stakeholder institutions in Uganda that support policy and decision making in the health sector. RESULTS All participants perceived HTA as an important tool for decision making. Allocative efficiency was regarded as the most important use of HTA receiving the highest average score (8.8 out of 10), followed by quality of healthcare (7.8/10), transparency (7.6/10), budget control (7.5/10), and equity (6.5/10). There was concern that some of the uses of HTA may not be achieved in reality if there was political interference during the HTA process. The study participants identified development partners as the most likely potential users of HTA (66.7 percent of participants), followed by Ministry of Health (43.3 percent). CONCLUSION Interviewed stakeholders in Uganda viewed the role of HTA positively, suggesting that there exists a promising environment for the establishment and operationalization of HTA as a tool for decision making within the health sector. However, sustainable development and application of HTA in Uganda will require adequate capacity both to undertake HTAs and to support their use and uptake.
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Affiliation(s)
- Chrispus Mayora
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Joseph Kazibwe
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Ssempala
- Department of Economic Theory and Analysis, Makerere University School of Economics, Kampala, Uganda
| | - Brenda Nakimuli
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Aloysius Ssennyonjo
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Elizabeth Ekirapa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Sarah Byakika
- Department of Planning, Financing and Policy, Ministry of Health, Kampala, Uganda
| | - Tom Aliti
- Department of Planning, Financing and Policy, Ministry of Health, Kampala, Uganda
| | - Timothy Musila
- Department of Planning, Financing and Policy, Ministry of Health, Kampala, Uganda
| | - Mohamed Gad
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Francis Ruiz
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Freddie Ssengooba
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
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Namyalo PK, Mutatina B, Byakika S, Walimbwa A, Kato R, Basaza RK. The feasibility analysis of integrating community-based health insurance schemes into the national health insurance scheme in Uganda. PLoS One 2023; 18:e0284246. [PMID: 37058490 PMCID: PMC10104299 DOI: 10.1371/journal.pone.0284246] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/27/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Uganda has a draft National Health Insurance Bill for the establishment of a National Health Insurance Scheme (NHIS). The proposed health insurance scheme is to pool resources, where the rich will subsidize the treatment of the poor, the healthy will subsidize the treatment of the sick, and the young will subsidize the treatment of the elderly. However, there is still a lack of evidence on how the existing community-based health insurance schemes (CBHIS) can fit within the proposed national scheme. Thus, this study aimed at determining the feasibility of integrating the existing community-based health financing schemes into the proposed National Health Insurance Scheme. METHODS In this study, we utilized a multiple-case study design involving mixed methods. The cases (i.e., units of analysis) were defined as the operations, functionality, and sustainability of the three typologies of community-based insurance schemes: provider-managed, community-managed, and third party-managed. The study combined various data collection methods, including interviews, survey desk review of documents, observation, and archives. FINDINGS The CBHIS in Uganda are fragmented with limited coverage. Only 28 schemes existed, which covered a total of 155,057 beneficiaries with an average of 5,538 per scheme. The CBHIS existed in 33 out of 146 districts in Uganda. The average contribution per capita was estimated at Uganda Shillings (UGX) 75,215 = equivalent to United States Dollar (USD) 20.3, accounting for 37% of the national total health expenditure per capita UGX 51.00 = at 2016 prices. Membership was open to everyone irrespective of socio-demographic status. The schemes had inadequate capacity for management, strategic planning, and finances and lacked reserves and reinsurance. The CBHIS structures included promoters, the scheme core, and the community grass-root structures. CONCLUSION The results demonstrate the possibility and provide a pathway to integrating CBHIS into the proposed NHIS. We however recommend implementation in a phased manner including first providing technical assistance to the existing CBHIS at the district level to address the critical capacity gaps. This would be followed by integrating all three elements of CBHIS structures. The last phase would then involve establishing a single fund for both the formal and informal sectors managed at the national level.
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Affiliation(s)
| | | | - Sarah Byakika
- Health Services, Planning, Financing and Policy Department, Ministry of Health, Kampala, Uganda
| | - Aliyi Walimbwa
- Health Services, Planning, Financing and Policy Department, Ministry of Health, Kampala, Uganda
| | - Rose Kato
- Belgian Development Agency (Enabel), Kampala, Uganda
| | - Robert K Basaza
- School of Public Health, Gudie University Project, Kampala, Uganda
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McBain R, Nandakumar AK, Ruffner M, Mann C, Hijazi M, Baker S, Morrison L, Chalkidou K, Zhang S, Semini I, Terris-Prestholt F, Forsythe S, Byakika S, Musinguzi J, Kaplan RS. A new initiative to track HIV resource allocation and costs. Bull World Health Organ 2022; 100:358-358A. [PMID: 35694617 PMCID: PMC9178425 DOI: 10.2471/blt.22.287818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ryan McBain
- Partners in Health, 800 Boylston Street, Boston, Massachusetts 02199, United States of America (USA)
| | - A K Nandakumar
- Office of the Global AIDS Coordinator at the United States Department of State, Washington, DC, USA
| | - Michael Ruffner
- Office of the Global AIDS Coordinator at the United States Department of State, Washington, DC, USA
| | - Carlyn Mann
- United States Agency for International Development, Washington, DC, USA
| | - Mai Hijazi
- United States Agency for International Development, Washington, DC, USA
| | - Susanna Baker
- United States Agency for International Development, Washington, DC, USA
| | - Linden Morrison
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Kalipso Chalkidou
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Shufang Zhang
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Iris Semini
- Fast Track Implementation Department, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Fern Terris-Prestholt
- Fast Track Implementation Department, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
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Byabagambi J, Marks P, Megere H, Karamagi E, Byakika S, Opio A, Calnan J, Njeuhmeli E. Improving the Quality of Voluntary Medical Male Circumcision through Use of the Continuous Quality Improvement Approach: A Pilot in 30 PEPFAR-Supported Sites in Uganda. PLoS One 2015. [PMID: 26207986 PMCID: PMC4514600 DOI: 10.1371/journal.pone.0133369] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Uganda adopted voluntary medical male circumcision (VMMC) (also called Safe Male Circumcision in Uganda), as part of its HIV prevention strategy in 2010. Since then, the Ministry of Health (MOH) has implemented VMMC mostly with support from the United States President's Emergency Plan for AIDS Relief (PEPFAR) through its partners. In 2012, two PEPFAR-led external quality assessments evaluated compliance of service delivery sites with minimum quality standards. Quality gaps were identified, including lack of standardized forms or registers, lack of documentation of client consent, poor preparedness for emergencies and use of untrained service providers. In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality. METHODS AND FINDINGS Sites were supported to identify barriers in achieving national standards, identify possible solutions to overcome the barriers and carry out improvement plans to test these changes, while collecting performance data to objectively measure whether they had bridged gaps. A 53-indicator quality assessment tool was used by teams as a management tool to measure progress; teams also measured client-level indicators through self-assessment of client records. At baseline (February-March 2013), less than 20 percent of sites scored in the "good" range (>80%) for supplies and equipment, patient counseling and surgical procedure; by November 2013, the proportion of sites scoring "good" rose to 67 percent, 93 percent and 90 percent, respectively. Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events. CONCLUSION Public sector providers can be engaged to address the quality of VMMC using a continuous quality improvement approach.
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Affiliation(s)
- John Byabagambi
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC (URC), Kampala, Uganda
| | - Pamela Marks
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC (URC), Bethesda, Maryland, United States of America
| | - Humphrey Megere
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC (URC), Kampala, Uganda
| | - Esther Karamagi
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC (URC), Kampala, Uganda
| | | | | | - Jacqueline Calnan
- Health Team, United States Agency for International Development (USAID), Kampala, Uganda
| | - Emmanuel Njeuhmeli
- Office of HIV/AIDS, Global Health Bureau, United States Agency for International Development (USAID), Washington, District of Columbia, United States of America
- * E-mail:
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Take N, Byakika S, Tasei H, Yoshikawa T. The Effect of 5S-Continuous Quality Improvement-Total Quality Management Approach on Staff Motivation, Patients' Waiting Time and Patient Satisfaction with Services at Hospitals in Uganda. J Public Health Afr 2015; 6:486. [PMID: 28299136 PMCID: PMC5349263 DOI: 10.4081/jphia.2015.486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 03/09/2015] [Indexed: 11/23/2022] Open
Abstract
This study aimed at analyzing the effect of 5S practice on staff motivation, patients' waiting time and patient satisfaction with health services at hospitals in Uganda. Double-difference estimates were measured for 13 Regional Referral Hospitals and eight General Hospitals implementing 5S practice separately. The study for Regional Referral Hospitals revealed 5S practice had the effect on staff motivation in terms of commitment to work in the current hospital and waiting time in the dispensary in 10 hospitals implementing 5S, but significant difference was not identified on patient satisfaction. The study for General Hospitals indicated the effect of 5S practice on patient satisfaction as well as waiting time, but staff motivation in two hospitals did not improve. 5S practice enables the hospitals to improve the quality of services in terms of staff motivation, waiting time and patient satisfaction and it takes as least four years in Uganda. The fourth year since the commencement of 5S can be a threshold to move forward to the next step, Continuous Quality Improvement.
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Affiliation(s)
- Naoki Take
- Kaihatsu Management Consulting, Inc. , Tokyo, Japan
| | | | - Hiroshi Tasei
- International Techno Center Co., Ltd. , Tokyo, Japan
| | - Toru Yoshikawa
- National Institute of Occupational Safety and Health , Kanagawa, Japan
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