| Table of contents |
Tables and Figures ............................................................................................................... vii
Preface ................................................................................................................................. xvii
Acknowledgments ............................................................................................................... xix
Abbreviations ...................................................................................................................... xxi
Key Findings ....................................................................................................................... xxv
Chapter 1 Survey Methodology ...................................................................................... 1
1.1 Overview ........................................................................................................ 1
1.2 Institutional Framework and Objectives of the USPA................................... 1
1.3 USPA 2007 Content and Methods for Data Collection ................................. 2
1.3.1 Content of the USPA 2007 ............................................................ 2
1.3.2 Methods for Data Collection ......................................................... 3
1.4 Sampling ........................................................................................................ 3
1.4.1 Sample of Facilities ....................................................................... 3
1.4.2 Sample of Health Service Providers .............................................. 6
1.4.3 Sample for Observations and Exit Interviews ............................... 6
1.5 Survey Implementation .................................................................................. 7
1.5.1 Data Collection Instruments .......................................................... 7
1.5.2 Training and Supervision of Data Collectors ................................ 8
1.5.3 Data Collection .............................................................................. 8
1.5.4 Data Management and Report Writing .......................................... 8
1.5.5 Data Analysis ................................................................................. 9
Chapter 2 Overview of the Health System in Uganda ................................................ 11
2.1 Health Status in Uganda .............................................................................. 11
2.2 Enabling Policies and Strategies to Improve Health Status ......................... 11
2.2.1 Uganda Development Vision 2025 .............................................. 12
2.2.2 Poverty Reduction Strategy ......................................................... 12
2.2.3 Millennium Development Goals ................................................. 12
2.2.4 National Health Policy ................................................................ 12
2.2.5 Health Sector Strategic Plan ........................................................ 12
2.2.6 Public Service Reform ................................................................. 13
2.2.7 Health Sector Reform .................................................................. 13
2.3 The Health Care System .............................................................................. 13
2.3.1 Introduction ................................................................................. 13
2.3.2 Functions of the National Health System .................................... 13
2.3.3 Government Stewardship ............................................................ 14
2.4 Organisation of the Health Care System ...................................................... 14
2.4.1 Ministry of Health and other National-Level Institutions ........... 15
2.4.2 Hospitals ...................................................................................... 15
2.4.3 District Health System ................................................................. 16
2.5 Human Resource Staffing ............................................................................ 18
2.6 Public Health Programmes (The Uganda National Minimum Health Care Package) ............................................................. 18
2.7 Health Financing .......................................................................................... 19
2.7.1 Introduction ................................................................................. 19
2.7.2 Goal ............................................................................................. 19
2.7.3 Financing Mechanisms for HSSP-II ............................................ 20
2.7.4 Government Budget and Donor Budget Support......................... 20
2.7.5 Donor Project Funding ................................................................ 20
2.7.6 Global Funding Initiatives ........................................................... 20
2.7.7 Community-Based Health Insurance Plans ................................. 21
2.7.8 User Fees in Private Wings of Public Hospitals .......................... 21
2.7.9 User Fees in PNFP Units ............................................................. 22
2.8 General Recommendations for Future Health Sector Planning (2005-2010) .......................................................................................... 23
Chapter 3 Facility-Level Infrastructure, Resources, and Systems ............................ 25
3.1 Basic Infrastructure and Resources to Support Utilisation of Services and Accessibility ........................................................................... 25
3.1.1 Availability of Services and Human Resources .......................... 25
3.1.2 Facility Infrastructure Supportive of Client Utilisation and Quality Services .................................................................... 28
3.1.3 Infrastructure and Resources to Support Quality 24-Hour Emergency Services .................................................................... 29
3.2 Management Systems to Support and Maintain Quality Services and Appropriate Client Utilisation ............................................................... 32
3.2.1 Management, Quality Assurance, and Referral Systems ............. 32
3.2.2 Supportive Management for Providers ........................................ 36
3.2.3 Management Practices Supporting Community Involvement ..... 37
3.2.4 Funding Mechanisms That Decrease Financial Barriers to Utilisation of Health Services ...................................................... 38
3.2.5 Maintenance and Repair of Equipment ....................................... 39
3.3 Logistics Systems for Vaccines, Contraceptives, and Medicines ................ 41
3.3.1 Storage and Stock Monitoring Systems for Vaccines ................. 43
3.3.2 Storage and Stock Monitoring Systems for Contraceptive Methods and Medicines ............................................................... 45
3.4 Systems for Infection Control ...................................................................... 48
3.4.1 Capacity for Adherence to Standards for Quality Sterilisation or High-Level Disinfection Processes ..................... 48
3.4.2 Appropriate Storage Conditions for Processed Items .................. 53
3.4.3 Infection Control in Service Delivery Area ................................. 53
3.4.4 Adequate Disposal of Hazardous Waste ..................................... 55
3.4.5 Injection Practices ....................................................................... 56
Chapter 4 Child Health Services .................................................................................. 59
4.1 Background .................................................................................................. 59
4.1.1 USPA Approach to Collecting Child Health Information ........... 59
4.1.2 Health Situation of Children in Uganda ...................................... 59
4.2 Availability of Child Health Services .......................................................... 61
4.3 Capacity to Provide Quality Immunisation Services ................................... 62
4.3.1 Capacity to Maintain the Quality of Vaccines ............................. 63
4.3.2 Availability of Vaccines and Vitamin A ..................................... 63
4.3.3 Availability of Equipment and Supplies for Vaccination Sessions ....................................................................................... 64
4.3.4 Availability of Administrative Components for Monitoring Immunisation Activities .............................................................. 65
4.4 Capacity to Provide Quality Outpatient Care for Sick Children .................. 66
4.4.1 Infrastructure and Resources to Support Quality Assessment and Counselling for the Sick Child .............................................. 67
4.4.2 Equipment and Supplies for Assessing and Providing Preventive Care for the Sick Child .............................................. 68
4.4.3 Essential Medicines for Treating Sick Children .......................... 69
4.4.4 Availability of Infection Control Items for Therapeutic Injections ..................................................................................... 72
4.5 Management Practices Supportive of Quality Sick Child Services ............. 73
4.5.1 Facility Documentation and Records .......................................... 73
4.5.2 Practices Related to User Fees..................................................... 73
4.5.3 Training and Supervision ............................................................ 74
4.6 Adherence to Guidelines for Sick Child Service Provision ......................... 76
4.6.1 Full Assessment of Illnesses ........................................................ 76
4.6.2 Diagnosis-Specific Assessments ................................................. 79
4.6.3 Other Observed Practices ............................................................ 81
4.6.4 Reducing Missed Opportunities for Promoting Child Health Care .................................................................................. 82
4.6.5 Counselling on Child Health Issues and Supporting Continuity of Care ....................................................................... 84
4.7 Caretaker Opinion from Exit Interviews ...................................................... 85
Chapter 5 Family Planning Services ............................................................................ 87
5.1 Background .................................................................................................. 87
5.1.1 USPA Approach to Collection of Family Planning Service Information .................................................................................. 87
5.1.2 Family Planning Services in Uganda ........................................... 88
5.2 Availability of Family Services ................................................................... 88
5.3 Components Supporting Quality Family Planning Services........................ 92
5.3.1 Infrastructure and Resources to Support Quality Family Planning ....................................................................................... 92
5.3.2 Infrastructure and Resources for Examinations ........................... 93
5.3.3 Provision of STI Treatment for Family Planning Clients ............ 95
5.3.4 Availability of Equipment and Supplies for Specific Methods ... 96
5.4 Management Practices That Support Quality Family Planning Services .... 98
5.4.1 Facility Documentation and Records .......................................... 98
5.4.2 Practices Related to User Fees..................................................... 99
5.4.3 Training and Supervision ............................................................ 99
5.5 Adherence to Standards for Quality Service Provision ............................. 100
5.5.1 Counselling and Client Assessment .......................................... 102
5.5.2 Method-Specific Assessments and Examinations ..................... 103
5.5.3 Counselling of Clients ............................................................... 104
5.6 Client Opinion from Exit Interviews ......................................................... 105
Chapter 6 Maternal Health Services .......................................................................... 107
6.1 Background on Maternal and Newborn Health Care in Uganda ............... 107
6.1.1 Definition of Maternal Health Concepts Used During Collection of USPA Information ............................................... 110
6.2 Availability and Capacity to Provide Quality Maternal and Newborn Care Services ......................................................................... 111
6.2.1 Availability of Antenatal and Post-partum Care Services ......... 111
6.2.2 Infrastructure and Resources to Support Quality Assessment and Counselling of ANC Clients ............................................... 112
6.2.3 Infrastructure and Resources for Examinations ......................... 113
6.2.4 Essential Equipment and Supplies for Basic ANC .................... 114
6.2.5 Additional Equipment and Supplies for Quality ANC and PPC Services ............................................................................. 114
6.3 Management Practices Supportive of Quality ANC and PPC Services ..... 117
6.3.1 Facility Documentation and Records ........................................ 117
6.3.2 Practices Related to User Fees................................................... 118
6.3.3 Training and Supervision .......................................................... 119
6.4 Adherence to Standards for Quality ANC Service Provision .................... 120
6.4.1 Appropriate Assessment and Examination for ANC Clients .... 120
6.4.2 Counselling to Promote a Healthy Outcome ............................. 122
6.4.3 Supporting Continuum of Care.................................................. 123
6.5 Client Opinion of Service Provision .......................................................... 124
6.6 Availability of Delivery Services and Capacity to Provide Quality Delivery Care ........................................................................... 124
6.6.1 Availability of Delivery Services .............................................. 124
6.6.2 Domiciliary care practices ......................................................... 125
6.6.3 Infrastructure and Resources to Support Quality Delivery Services ..................................................................................... 126
6.7 Newborn Care Practices ............................................................................. 133
6.8 Management Practices Supportive of Quality Delivery Services .............. 134
6.8.1 Facility Documentation and Records ........................................ 134
6.8.2 Systems for Quality Assurance, Including Maternal Death Reviews ..................................................................................... 135
6.8.3 Practices Related to User Fees................................................... 135
6.8.4 Training and Supervision .......................................................... 136
6.9 Availability of Emergency Obstetric Care ................................................. 137
6.9.1 The Signal Functions for EmOC ............................................... 137
Chapter 7 Services for Communicable Diseases: Sexually Transmitted Infections, Reproductive Tract Infections, and Tuberculosis ................ 139
7.1 Background ................................................................................................ 139
7.1.1 Uganda Service Provision Assessment Approach to Collection of Information on Sexually Transmitted Infections and Tuberculosis ............. 139
7.1.2 Health Situation Regarding STIs and RTIs in Uganda .............. 140
7.1.3 Health Situation Regarding Tuberculosis in Uganda ................ 140
7.2 Availability of STI Services ...................................................................... 141
7.3 Capacity to Provide Quality STI Services ................................................. 142
7.3.1 System Components to Support Utilisation of Services ............ 143
7.3.2 Infrastructure and Resources to Support Quality Assessment and Counselling ....................... 143
7.3.3 Infrastructure and Resources for Examinations and Treatment ......................................... 146
7.4 Management Practices Supportive of Quality Services ............................. 149
7.4.1 Facility Documentation and Records ........................................ 149
7.4.2 Training and Supervision .......................................................... 150
7.5 Adherence to Standards for Quality Service Provision ............................. 151
7.5.1 Assessment of Relevant History ................................................ 152
7.5.2 Physical Examinations (Including Pelvic) and Infection Control .......................................... 152
7.5.3 Client Counselling ..................................................................... 153
7.5.4 Client Opinion from Exit Interviews ......................................... 153
7.6 Resources for Diagnosis and Management of Tuberculosis ...................... 155
7.6.1 Tuberculosis Diagnosis ............................................................. 155
7.6.2 Tuberculosis Treatment and Availability of Medicines ............ 156
7.6.3 Tuberculosis and HIV/AIDS Services ....................................... 157
Chapter 8 Malaria Services ......................................................................................... 159
8.1 Background ................................................................................................ 159
8.1.1 Malaria Endemicity and Burden of Disease .............................. 159
8.1.2 Malaria morbidity and mortality................................................ 160
8.1.3 The Malaria Control Strategy .................................................... 160
8.1.4 Malaria Diagnosis ...................................................................... 161
8.2 Availability of Services for Malaria .......................................................... 161
8.2.1 Malaria Diagnosis and/or Treatment ......................................... 161
8.2.2 Malaria-related Training for Providers ...................................... 163
8.3 Malaria Services for Sick Children ............................................................ 164
8.3.1 Availability of First-line Anti-malarial Medicines for the Treatment of Malaria in Children ............ 164
8.3.2 IMCI Assessment among Children Diagnosed with Malaria .... 165
8.3.3 Physical Examination ................................................................ 166
8.3.4 Treatment ................................................................................... 166
8.4 Malaria Services for ANC Clients ............................................................. 166
8.4.1 Provision of Insecticide-treated Mosquito Nets in Antenatal Care Clinics ............................. 168
8.4.2 Intermittent Preventive Treatment of Malaria ........................... 168
8.5 Malaria Services among Facilities Offering HIV/AIDS Care and Support Services ..................... 169
Chapter 9 HIV/AIDS Services .................................................................................... 173
9.1 Background ................................................................................................ 173
9.2 Definition of HIV/AIDS Indicators ........................................................... 174
9.3 Basic-Level Services for HIV/AIDS ......................................................... 175
9.3.1 Counselling and Testing ............................................................ 175
9.3.2 HIV/AIDS Care and Support Services ...................................... 177
9.4 Advanced-Level Services for HIV/AIDS .................................................. 184
9.4.1 Advanced-Level Treatment of Opportunistic Infections and Palliative Care for HIV/AIDS ....... 184
9.4.2 Antiretroviral Therapy (ART) ................................................... 186
9.4.3 Prevention of Mother-to-Child Transmission (PMTCT) of HIV .................. 187
9.4.4 Post-Exposure Prophylaxis ........................................................ 189
9.4.5 Youth-Friendly Services (YFS) ................................................. 190
References ........................................................................................................................... 191
Appendix A Additional Tables ....................................................................................... 197
Appendix B Weighting of Facilities in the 2007 USPA ................................................ 367
Appendix C Survey Personnel ........................................................................................ 369
Appendix D Survey Instruments .................................................................................... 371 |
