A nurse attends to a patient at
The Service Delivery Indicators report had noted that "doctors in
Ugandan health workers were not happy.
"Grossly inaccurate," is how the Chairperson of the UMDPC, Prof.
"If the report is true," Prof. Okullo said, "why is it that Ugandan doctors are in high demand elsewhere?"
He cited a request by the
"Evidence around the world shows that when Ugandan doctors go abroad, they perform far better, and so it is not an issue of knowledge or competence but may actually be a result of the poor working environment."
Okullo added: "This is not to say that we don't have challenges of incompetence, but not as worse as the
The Independent has tracked down Waly Wane, the
Wane says, as in other five countries where the Service Delivery Indicators (SDI) survey has been done so far, it is intended to provide a snapshot of the state of health systems and should not be viewed "narrowly as a criticism of the health providers".
The report was first released in
Wane said it was based on surveys of 400 health facilities, and nearly 739 health providers of which 27 were doctors, 134 clinical officers, 404 nurses and mid-wives, and 174 other health professionals.
"The survey therefore captured the experience of the vast majority of Ugandans seeking care," Wane told The Independent in an email.
Wane however admitted that because the sample size of the health providers who self-identified themselves as 'medical officer' or 'specialist,' the results on doctors may specifically have had 'large standard errors' or may not be 'highly precise.' He said the SDI report never referred to the Ugandan doctors as incompetent.
"For the six countries where the SDI was done, the results show that for diagnostic accuracy, Ugandan health providers are second only to
"Ugandan health providers score better at adhering to guidelines than their Kenyan counterparts," he said.
The SDI report clearly notes that Ugandan health providers are working in challenging conditions when it comes to the availability of drugs and proper infrastructure especially when compared to
Better off in town
The quality of service in the health sector was assessed using indicators such as adherence to clinical guidelines in five tracer conditions and management of maternal and newborn complications. Tracer conditions were defined by the
Three of the tracer conditions were childhood conditions (malaria with anaemia, acute diarrhoea with severe dehydration, and pneumonia), and two were adult conditions (pulmonary tuberculosis and diabetes mellitus).
Two other conditions were included; post-partum haemorrhage, the most common cause of maternal death during birth; and neonatal asphyxia, the most common cause of neonatal death during birth.
The survey which was first done in
The SDI survey also found that service providers in government health facilities had slightly less diagnostic accuracy than those in private practice at 56% compared to 60%, while those in towns were better than those in rural areas at 70% compared to 50%.
The report notes that the "correct treatment was recommended in only 36% of the cases, reflecting weak provider knowledge."
"It is 'alarming' to note that although almost 9 out of 10 (88%) providers were able to correctly diagnose pulmonary tuberculosis, nearly half (47%) did not prescribe the correct treatment required," the report reads in part.
The health providers' knowledge and treatment also varied across conditions, with malaria and anemia being the least likely to be correctly diagnosed and less than one in 10 (8%) receiving the correct treatment.
The report noted that it was worrying that so few health providers were able to even diagnose potentially deadly conditions such as malaria and diarrhoea.
The report further says that although
There were also large differences across regions with health providers in the northern region scoring lower in terms of diagnostic accuracy. Overall diagnostic accuracy was significantly higher in
The survey also took into account the availability of minimum equipment and drugs expected at a facility (weighing scale for adults, children or infants, a stethoscope, a blood pressure machine and a thermometer).
In terms of health facility infrastructure, 90% of facilities had access to sanitation, more than 90% had access to clean water, and close to three quarters (74%) had a source of electricity. This according to the
In terms of drug availability, defined as the number of drugs of which a facility has one or more available, as a proportion of all the drugs on a list of 26 tracer medicines for children and mothers identified by WHO. On average only 47% of this long list were available.
However, when the six major tracer drugs on
On average, 79 % of the six tracer drugs were available at the facilities. However, less than half (49%) of the priority drugs for children and close to one out of three (35%) priority drugs for mothers were available.
Government facilities worst
In government health facilities, the rural had poorer equipment and infrastructure. However, the availability of drugs was higher in rural facilities. The northern and eastern regions were worse off in almost all dimensions except for drugs, which were available in more than 90% of northern health facilities.
Another indicator for health provider's level of effort is patient caseload (the average number of outpatient visits a health provider attends to per working day).
According to the report, the average health provider consulted with 6.1 outpatients per day, a surprisingly low number.
But smaller facilities staffed with one or two health providers had the largest caseload with 11 outpatients per provider per day, which is more than twice the load for facilities with 3 to 5 providers [5.3 outpatients].
Very large facilities with more than 20 health providers recorded a caseload of only 2.1 outpatients.
High level of absenteeism
To gauge the poor utilization of the few health providers available in
According to the report, more than half (52%) of public health providers were not present in the facility with 60% of this absence approved, and hence potentially within management's power to influence.
The western and central regions had the highest absenteeism with roughly 6 out of 10 health providers absent.
In the majority of cases, respondents gave a legitimate reason for the absence of health workers--such as attending training or a seminar (15%), on official mission (10%), or other approved absence (25%).
"A typical expected absence rate is about 5 to 10% authorized leave. The rates in
"From the citizen's perspective, if almost half of staff is not attending to patients, there is a legitimate reason for concern even if every single absence was sanctioned."
It recommends better management at the facility or higher administrative level could probably curb sanctioned absence by implementing tighter leave rules.
There is a lot of regional and public-private variation in providers' level of effort. Starting with the caseload, public health providers' caseload (10 outpatients per provider per day) was almost five times that of private providers (2.2 outpatients).
Within the public sector, rural providers' caseload was more than twice that of urban providers. Public health facilities with only 1 or 2 health providers were the busiest and received 18.6 outpatients on a daily basis.
Although basic inputs and infrastructure--with the notable exception of drugs--are largely available at health facilities across
The big picture
According to the report,
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