Uganda

To help build the health workforce in Uganda, the Capacity Project is assisting the Ministry of Health to strengthen its human resources management and ability to gather and use accurate data for strategic planning. Drawing on key policy questions developed by the Health Workforce Advisory Board, the Capacity Project installed a certification and licensing information system at the four health professional councils and a human resources management system at the Ministry of Health.

After a curriculum review, Makerere University’s longstanding traditional curriculum was converted to a problem based learning curriculum with a focus on Community Based Education and Service (COBES). As a component of COBES, radiography, medical, nursing, dentistry and pharmacy students are sent to community health facilities where they are expected to participate in community services and other primary healthcare activities.

This document discusses the in-country ownership of health initiatives from the Health Sector Strategic Plan focusing on critical areas such as retention, recruitment and occupational safety.

In what areas do the HIV/AIDS donor programs interact with key operational parts of health systems? To answer it, and to better inform the ongoing discussion of AIDS and health systems, the report investigates and compares the donors’ interactions in three countries (Mozambique, Uganda, and Zambia) with three components of health systems: the health information system, the supply chain system for essential medicines, and human resources for health. [from summary] Chapter 4 is dedicated to the HRH aspects of this issue.

This paper looks at the HRH crisis as experienced by the Uganda Catholic Medical Bureau network giving the trend, examining the reasons, the destinations of attritional cases and what the network is trying to do to improve human resource stability. [from abstract]

This article describes the experience of the Family Life Education Programme, a reproductive health program that provides community-based health services through 40 clinics in five districts of Uganda, in improving retention and performance by using the Human Resource Management Rapid Assessment Tool. [adapted from abstract]

The purpose of this study was to identify and recommend strategies for tackling the underlying issues in the human resources for health (HRH) management process in Uganda with an eye towards addressing the HRH crisis. [from executive summary]

This document explores some FBO health networks and facility-based services in Uganda and Tanzania. A pilot project in the Kasese District of Uganda illustrates how protestant, catholic and muslim health care providers and communities can work together from household-to-hospital levels to improve health outcomes. [from author]

The mapping exercise illustrated in this report was conducted to inform and support the efforts of the Ugandan Ministry of Health to increase the contraceptive prevalence through enhanced community-based distribution (CBD) of family planning. The specific objectives of the exercise were to determine the historical and current coverage of CBD of family planning services in Uganda, by both governmental and nongovernmental programs, and to identify potential districts for scaling up these services. [adapted from summary]

The objective of this study was to assess whether traditional birth attendants, drug-shop vendors, community reproductive-health workers, or adolescent peer mobilizers could administer intermittent preventive treatment (IPTp) for malaria with sulfadoxine-pyrimethamine to pregnant women. The study concludes that the use of the guideline with adequate training significantly improved correctness of malaria treatment with chloroquine at home. Adoption of this mode of intervention is recommended to improve compliance with drug use at home. The applicability for deploying artemisinin-based combination therapy at the community level needs to be investigated.

This presentation was given at the First Forum on Human Resources for Health in Kampala. It describes a study to identify the level of satisfaction and intent to stay among health workers and effort to develop strategies to improve retention. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It discusses the key features of the Problem-Based Learning/Community-Based Education and Service innovations to the health curricula at Makerere University, why they implemented these improvements and the benefits they have seen from the program.

In an initiative to collate experiences on management development in low resource settings, WHO carried out case studies to explore management development approaches and how these impacted managerial and service delivery performance. [adapted from author]

This study explores the views of nursing students in Uganda to assess their views on professional practice options and their intentions to migrate to wealthier countries. The surveys show that most students would like to work outside of Uganda. The authors conclude that nursing schools may want to recruit students desiring work in rural areas or public practice to lead to a more stable workforce in Uganda. [adapted from author]

Staff shortages could harm the provision and quality of health care in Uganda and therefore staff retention and motivation are crucial. Understanding the impact of HIV/AIDS on staff contributes to designing appropriate retention and motivation strategies. This research aimed to identify the influence of HIV/AIDS on staff working in general hospitals at district level in rural areas and to explore support required and offered to deal with HIV/AIDS in the workplace. Results from interviews and surveys show that HIV/AIDS is an important contextual factor that impacts working conditions in various ways.

In both Asia and Latin America, community-based health workers have been trained in safe injection techniques and routinely provide injectable contraception. However, the African continent still resists this service delivery mechanism with the rationale that it is unsafe for clients to receive injections from paramedical personnel. This argument is weakening, however, as non-reusable syringes become the norm and with the recent development of a checklist, based on the latest WHO Medical Eligibility Criteria, for safe provision of DMPA by community-based agents.

This report summarises the results of a study of health worker satisfaction, working conditions and intent to continue working in the health sector in Uganda. The findings point to the importance of a number of factors that contribute to satisfaction and intent to stay, including differences by cadre, gender, age, sector (public or non-profit) and location. The results suggest several policy strategies to strengthen human resources for health in Uganda. [from abstract]

The Ministry of Health Manpower Development Centre in Uganda has been carrying out training of health workers as part of their continuing education using both distance education and conventional methods since 1989. It was important, therefore, to develop a comprehensive documentation of the distance learning programmes in order to show the effectiveness and potential of distance education in upgrading medical personnel as compared to other approaches. [from author]

While the availability and use of trained midwives can shape the quality of care received in pregnancy and childbirth, a number of other underlying health systems structures and processes are important. The management of health workforces, the mix of public and private provision and the impact of reforms affect quality of care across countries…[This study] examined how the structure and operation of a health system influences maternal health care provision and outcomes in Bangladesh, Russia, South Africa and Uganda. [author’s description]

The importance of human resources in health systems needs not to be over-emphasised. Expenditure on health workers forms a significant proportion of total health expenditure in many countries. In order to effectively implement cost-effective interventions, health workers must have the appropriate skills, competencies, training and motivation to do so. However, current evidence suggests that health systems in developing countries are understaffed and exhibit maldistribution of health workers. Health workers are generally demotivated and less productive due to inappropriate incentive environment.

For long now, doctors in Uganda have been complaining that their terms of service, particularly remuneration, are not commensurate with the years that they spend training and the amount of work that they do. This issue has persistently been raised at several fora over the years but with no definite resolution. But how should doctors be paid? This paper attempts to answer this question. In the developed world, policy makers attempt to answer the question of cost containment. In Uganda, due to limited financial resources, the overriding question is where will the extra resources to adequately pay doctors be found? [from introduction]

Uganda has been successful in implementing the national “Health Management Information System” (HMIS). Disease surveillance reports and monitoring of key output indicators within the health sector seem to be the areas with the most remarkable advance. But little mention has been made on the importance of the use of information for monitoring performance indicators and for management/decision making purposes. The existing HMIS makes this possible.

At the inception of Uganda’s second 5-year Health Sector Strategic Plan (HSSP II), this paper traces the history of the public - private partnership for health (PPPH) in Uganda, giving its justification and mandate. It also gives its current state of the art, outlining the successes scored, the challenges still faced in its implementation and current efforts being made to make it comprehensively institutionalized. [abstract]

The Health Sector Strategic Plan (HSSP) aims to ensure access to basic health care by the Ugandan population. This requires availability of well-trained health professionals. This study demonstrates that the Private-Not-For-Profit Health Training Institutions - the majority in Uganda - have remained grossly under-funded, which poses a threat to achievement of the HSSP. It is recommended that government increases and guarantees its support to these Health Training Institutions as a way of maintaining quality of health worker training. [from abstract]

The study whose summary is presented here tried to compare the attrition rates in three Private Not For Profit and three Government General Hospitals in West Nile Region over a period of five years. It also examined the destination to which the health professionals were lost, the source of the new staff that replaced those lost by the hospitals, the reasons for attrition as perceived by the existing staff in the hospitals, what kept some of the staff working for longer period than others who chose to leave, and the incentives that were in place for attraction and retention of health professionals in these hospitals.

In Yumbe District of north-western Uganda, Village Health Teams (VHT) have been established in line with the national strategy for community involvement in health. The Yumbe VHT programme has won an award for innovative support to strengthening decentralisation. This paper reviews aspects of the programme outlining its successes and challenges.

A goal of the health management information system (HMIS) is to provide reliable, comprehensive information about the health system to health managers, to enable them take decisions that will improve the services provided to the consumers. This study assessed the utilisation of HMIS data for decision making at the grassroots level in Bufumbira East Health Sub-District (HSD) of Kisoro District. [from abstract]

IMCI was launched in Uganda in June 1995 and has so far been implemented in most districts. However, reports indicate that counselling is poorly performed and that health providers find IMCI counselling the most difficult component to implement. The study was carried out to assess IMCI-trained health providers’ counselling of caregivers and to determine factors that facilitate or constrain counselling. [from abstract]

A scarcity of trained medical personnel impedes Uganda’s ability to deliver healthcare effectively. The role of the Clinical Officer (CO) was established to assist the provision of primary healthcare to rural communities. The primary aim of this study was to explore the role that the CO performs in delivery of primary and secondary healthcare in Uganda. A secondary aim was to determine the resources and facilities that are available to COs in order to carry out these duties. A further aim was to determine the confidence of COs at performing surgical and obstetric procedures. [from introducti

The objective of this study was to explore knowledge, attitudes and practices of health workers in Mulago hospital towards domestic violence prevention and management, especially violence during pregnancy. Many respondents had poor knowledge of domestic violence management or prevention. Though they believed counseling survivors was necessary, none of the in-depth interviewees had counseling skills or had ever referred patients or survivors for such counseling.