Master of Science Health Services Management

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Assessment of the Performance of the Affordable Medicines Facility Malaria (AMFM) Program in Uganda.
(International Health Sciences University, 2013-09) Owori, Ojambo Joshua
This study is an assessment of the performance of the affordable medicines facility malaria (AMFm) program in Uganda, a case study of selected pharmacy out lets in Kampala district. The main objective of the study was to assess the performance of AMFm in ensuring accessibility, affordability, proper use and increasing the market share in the selected outlets in Kampala in 2013 And the specific objectives were; 1. To determine the availability of AMFm ACTS in the selected facilities in Kampala 2013. 2. to determine the afford ability of ACTS in line AMFm price norms in selected facilities in Kampala in 2013. 3. To assess the knowledge ability of the sellers/ distributors of ACTs dosage and prescription in the selected facilities in Kampala in 2013. 4. To assess the market share of the ACTs under AMFm in the market in the selected facilities in Kampala 2013. Across sectional study design was used to study 169 pharmacy outlets in Kampala with 338 respondens purposely selected in public, private not for proft and private for profit pharmacy outlets in all the divisions of Kampala. The major findings of the study were that the majority of the pharmacy out lets have the AMFm ACTs most times and there was a high level of knowledge of various doses despite some degree of errors. The cost of the AMFm ACTs in most outlets was above the recommended prices hence negatively impacting on affordability. The market share was estimated to be 50% which is still low though promising. The study recommends increased awareness to be done by the Ministry of the availability of the AMFm ACTs and their expected retail prices. Also the distributors, suppliers and retailers should adhere to the recommended prices at all levels. And also further similar studies should be done in the rural settings.
Assessment of the Prevalence of Occupational Health Related Injuries and Use of Safety Measures Among Employees in Brewery Factory in Rwanda :
(International Health Sciences University, 2012-09) Mbonigaba, Edward
Background Worldwide, occupational health related injuries have become potential public health issue leading to disability and death causing abandonment of work. Rwanda is one developing country which is at risk of having work related injuries due to the fact that its industrial economy is growing at a very fast rate which has attracted many investors in industrial sector. Objectives: To assess the prevalence of occupational health related injuries and use of safety measures among employees and specifically to identify the types of occupational health related injuries suffered by the brewery employees, establish the occupational safety measures in place at Bralirwa processing industries in Gisenyi Rwanda and identify factors influencing use of occupational safety measures among the brewery employees in Bralirwa processing industries in Gisenyi Rwanda Methods: This was a descriptive cross-sectional study design carried out in Bralirwa processing industries in Kigali Rwanda from August to October 2012. This study employed mainly quantitative methods of data collection. A sample of 220 respondents was selected. Quantitative data were collected using semi-structured questionnaires and observational check list. Data was analyzed using SPSS version 17 and Stata soft ware computer packages. The study findings were summarized using proportions, percentages, frequencies and presented tabular format and figures. Results Majority 72.7% (160/220) of the respondents were male. Half 50% (110/220) of the respondents were in the age range of 31-45 years. The findings indicated that 86.4% (190/220) of the respondents reported having suffered from occupational health related injuries. The injuries suffered were mainly physical injuries like falls, cuts and electrocutions. The ergonomic related injuries were mainly many 25.5% (56/190) of them reported falls, 21.8% (48/190) reported cuts, 17.7% (39/190) reported electrocution, only 8.6% (19/190) and 4.5% (10/190) reported fractures and dislocations as ergonomic risks experienced by them in the last 12 months respectively. The factors influencing use of occupational safety measures cited by the respondents included provision of personal protective equipment, training at work place on use the safety equipment, regular supervision, job satisfaction, sleeping disorders, alcohol consumption and work related risk experience (ever got injury). Conclusions Physical and ergonomic injuries, falls, cuts, electrocutions, fractures and dislocations were the most prevalent injuries suffered by the employees at at Bralirwa processing industries Gisenyi, Kigali Rwanda. The factors noted to influence use of occupational safety measures at Bralirwa processing industries included provision of personal protective equipment, training of the workers on use the safety equipment, regular supervision, job satisfaction and alcohol consumption Recommendations The industry management should carry out regular OSH assessments and meeting as required by national law and follow up on risks identified during the assessment. And supervision should be tightened to ensure that all workers at the job put on personal protective equipments.
Costing of St. Francis Nyenga Hospital Health Services for Financial Year 2012/2013.
(International Health Sciences University, 2013-09) Kamara, Ronald
This study was to cost the health services provided by Nyenga Hospital in the FY 2012/2013. The main objective of the study was to establish the average cost of providing a unit output of a service in Nyenga hospital and the specific objectives were to: i. To determine the total cost of providing services for the financial year 2012/13 ii. To determine the average cost per unit output for the financial year 2012/2013 iii. To determine the average cost recovery per cost service charged in the FY 2012/13.The study was a retrospective descriptive costs analysis study using a step down costing methodology (Shepard 1998). The cost of providing health services in Nyenga in the financial year 2012/2013 was determined using relevant data from 1st July 2012 to 30th June 2013. The study therefore recommends; i. The hospital should use this information to justify need for more financing other than user fees to government and other development partners. ii. The facility should adopt a flat rate for all services in OPD as this will enhance certainty and hence utilization iii. Since the theatre is underutilized the facility should consider revising the charges downwards and benefit from increased utilization and economies of scale and consider employing a surgeon. iv. Efficiency gain measures in terms of medicines selection and prescriptions should be implemented in attempt to reduce costs. v. Government should increase support to the facility if it has to remain providing quality services at a low cost Further studies should be done to cost other related levels of care to be able to make comparisons.
Determinants of Overweight and Obesity Among Primary Four to Seven Pupils in Selected Schools in Mukono and Kampala City, Uganda.
(International Health Sciences University, 2013-09) Nawangi, Teckla Kevin
Background to the study Childhood obesity on the worldwide is still increasingly recognized as one of the most serious public health challenges of the 21st century. This is mainly attributed to the global nutritional transition from consuming healthy to less healthful diets. In Uganda, broad based interventions that have been instituted such as support policies and population-wide initiatives that include nutrition labeling, food taxes, and social marketing campaigns are yet to yield results. Purpose and problem statement The study was a way of assessing the determinants of childhood overweight and obesity among pupils attending schools. This was mainly because fewer interventions in overweight and obesity would predispose pupils to many diseases that would render the tomorrow generation unproductive. Methodology The study utilized a cross-sectional, descriptive study design in which questionnaires and interviews were administered to 409 pupils in Kampala city and Mukono district alongside their head teachers as key informants. Quantitative and qualitative data was collected and analyzed. WHO Anthroplus software was used to calculate the Z-scores for the pupils. The Pearson’s chisquare was used to establish factors influencing overweight and obesity amongst the children. Qualitative data was analyzed using a narrative approach. Findings and recommendations The study found out that the prevalence of overweight and obesity stands at 4.1% and 3.8%, respectively. It also established that behavioral factors like feeding habits in terms of the number of meals normally consumed per day and phyco-social factors do not significantly contribute to the nutrition status in overweight and obesity. However, gender and age of the pupil, family economic status, the means of transport, family history of obesity, physical activities alongside the type of school are contributing factors to overweight and obesity in pupils. Based on the study findings, we recommend among others, that government and non-government organizations leverage items of knowledge through effortless sensitization to both the parents and pupils on the implications of overweight and obesity. This would help to develop concerted efforts towards averting the growing trends of overweight and obesity among primary pupils attending schools. Also, the ministry of education and sports through its examining body the Uganda National Examinations Board should find ways of extending some marks to children involved in school physical activities.
Determination of Actual Human Resources for Health Staffing Requirements Using the Workload Indicators for Staffing Needs Methodology.
(Internationl Health Sciences University, 2012-09) Patrick, Nalere
Uganda has chronically had inadequate numbers of trained health personnel, poor equitable distribution of the human resources, poor skills mix and ineffective use of available human resources with non-professional task shifting in place. The study determined the appropriate number, cadre mix and the work-related pressures experienced at different level of health Centres in Mityana District in order to enhance effective and efficient use of human resources for health (HRH). The study adopted the Workload Indictors for Staffing Needs Methodology (WISN) process and data analysis package as developed by Shipp, (1988) which is currently being piloted and rolled out in Uganda. Health Unit monthly reports summarized in the HMIS 105 and HMIS 108 for a period from January 2011 to December 2011 in all the 32 public health facilities was used for data collection. The findings reveal that the district in 2011 had 254 health workers consisting of 10 Doctors, 26 Clinical Officers, 83 Midwives, 105 Nurses and 30 Nursing Assistants. Yet, according to the WISN staffing requirements, the district is supposed to have 16 Doctors, 29 Clinical Officers, 55 Midwives, 92 Nurses and 57 Nursing Assistants, giving a deficit of 5 health workers in total. To meet the district WISN staffing requirements there is need to: recruit more health worker per facility deficit, improve the equitable distribution by cadre, reduce un-professional tasking shifting, budget for human resources for health as well as implement incentive scheme for hard to reach and to stay areas.
Determination of Knowledge, Attitude and Perception of Employers and Employees Towards the Proposed National Health Insurance Scheme in the Central Region - Kampala District.
(International Health Sciences University, 2011-09) Mugisha, William
Introduction. The purpose of this research was to determine the employers and employee’s Knowledge, Attitude and Perception towards the proposed National Health Insurance Scheme in Uganda. The major research objective was to determine the level of knowledge, attitude and perception of employers and employees in the private sector on National Health Insurance Scheme in Uganda. The specific objectives of the research were; to determine the level of employers and employees knowledge on proposed National Health Insurance Scheme, to establish the attitude of employers and employees towards the proposed National Health Insurance Scheme and to establish the employers and employees perception of the proposed National Health Insurance Scheme Methodology A cross section survey research design was used with both quantitative and qualitative data collected using a sample size of 384 respondents. Research findings Findings indicate that there is lack of adequate information to employers and employees and those with a clue about NHIS had inadequate information and with total lack of what the Scheme is to offer. Further, majority responded that whereas the idea is good, the poor services in government hospitals and the existing corruption in the country may not allow delivery of quality health care.That there is need to first eliminate all the corrupt officials, put in place all the required equipments, motivate health workers and then implement the new scheme- NHIS. Recommendations Basing on the findings the study recommends that the government carries out an aggressively tailored sensitization/ promotional program that is geared towards enhancing employee and employers’ knowledge, attitude and perceptions towards NHIS. Further studies should be done to establish facility level of readiness to provide the service for NHIS.
Factors Influencing the Utilisation of Paediatric HIV Services by HIV Positive Mothers in Kampala District :
(International Health Sciences University, 2013-09) Naikaali, Irene Ssentongo
Background: While adult utilisation of HIV services is increasing in Uganda, the utilisation of similar services by children is still lagging behind. It is reported that only 3 out of 10 HIV positive children in Uganda are able to receive the HIV care services they need to survive childhood. This study examined factors influencing the utilisation of paediatric HIV services by known HIV positive mothers at Kamwokya Christian Caring Community (KCCC) to be able to facilitate the designing of appropriate and effective interventions that will facilitate the scale up of paediatric HIV service utilization at KCCC and Kampala district at large. Methodology: A cross sectional survey was conducted among 320 HIV positive mothers aged 15 years and above accessing HIV services at KCCC. Semi structured questionnaires and a focused interview guide were used to collect data after obtaining written consent. Data was entered and analyzed in Epi data and SPSS soft ware. Univariate, Bivariate and Multivariate analysis was done to identify factors influencing the utilisation of Paediatric HIV services by the HIV positive mothers. Results: At bivariate analysis, the study revealed the following factors having a significant relationship with utilization of paediatric HIV services by the HIV positive mothers; Marital status, duration in marriage, Knowledge of signs and symptoms of HIV in children, awareness about availability of free HIV services for children, disclosure of child’s HIV status, discrimination by family members and power relations in a home. Further analysis at multivariate level identified only the awareness about the availability of free HIV services for children as the single factor independently predicting utilisation of paediatric HIV services by the HIV positive mothers OR 11.95 95% (2.38-50.46). Conclusion: Continued sensitization of parents about availability of free HIV services for children together with deliberate efforts to link mothers to HIV service points for children are essential measures in scaling up utilisation of HIV services for children in Uganda
Health Facility Challenges in Meeting the Psychosocial Needs of HIV Perinatally - Infected Adolescents:
(International Health Sciences University, 2013-09) Agnes, L Kimara
Effectively addressing the psychological needs of HIV perinatally infected adolescents in Uganda is no only critical to avert risk taking behavior, impaired adulthood and premature death of the adolescent but also for the achievement of every one of the millennium development goals and yet the issue remains a challenge to HIV/AIDS treatment and care health facilities. Study objectives The main objective of the study was to establish the health facility's challenges in meeting the psychosocial needs of HIV positive perinatally infected adolescents attending Mildmay Uganda. Four specific objectives guided the study; To assess the adolescent's exceptions in relation to the services offered; examine the adequacy of infrastructure; determine the human resource factors; and examine the adequacy of funding for meeting the adolescents' psychosocial needs. Methodology A cross sectional research design involving the use of both qualitative and quantitative research methods was employed to study a population of 121 participants comprising 100 adolescents aged 14 to 19 years with perinatally acquired HIV-1; 15 health workers directly involved with adolescents; and 6 key informants. The results were summarized by use of tabulations, charts, graphs and percentages. Results The study showed that although Mildmay Uganda in general, offers commendable treatment and care for HIV perinatally infected adolescents by having in place an adolescent unit, adolescent friendly staff; training and workshops for both staff and patients, and has adolescent engagement to some degree, there are several constraints. The major challenges established include; inadequate funding; inappropriate infrastructure, human resource factors namely; inadequate numbers,inappropriate knowledge, attitude and skills in adolescent issues. The other challenges were a mismatch between adolescents expectations and the services delivered, high percentage of orphaned and financially needy adolescents, poor educational achievement and increasing sexual and reproductive health needs of adolescents. Recommendation the study recommends that government and donors increase funding for HIV/AIDS adolescents' psychosocial care, institute interdisciplinary training programs in adolescent health, ensure the establishment of youth friendly and youth led health services and initiate programs that target vulnerable “post adolescent”/young people. Mild may Uganda ought to seek for additional sources of funding for adolescent's support, establish adolescent friendly services, life skills and vocational skills training, increase adolescent's involvement, strengthen the management of pertinent issues of adolescence; and build the capacity of the family members to give effective psychosocial care for adolescents.
Implementation of Infection Control Measures in Health Facilities in Uganda:
(International Health Sciences University., 2013-09) Matovu, Ahmed
This study was to determine factors influencing implementation of infection control (IC) measures in health facilities in Kayunga district. The main objective of the study was to assess factors influencing implementation of IC measures in health facilities in Kayunga district in order to generate information useful to the Kayunga district health team and other stakeholders to design appropriate strategies to improve implementation of IC measures. And the specific objectives were: To determine the level of knowledge on IC measures by health care workers (HCW); to determine the attitude of HCW towards implementation of IC measures; to assess the extent to which HCW practice implementation of IC measures; to assess the availability of supplies required in implementation IC. Methodology: This was a cross-section study with a sample size of 197. A semi-structured questionnaire and an observational check list were used to collect data. The study population was health facilities and HCW who were sampled from the health facilities in the district. Data was collected on the level of knowledge on IC measures, attitude of HCW towards implementation of IC measures, extent to which HCW practice implementation of IC measures in and availability of supplies required in implementation IC measures. Bivariate analysis was conducted using Epi Info 2002 version computer programmes. Results Factors favouring implementation of IC measures were: being able to explain the term IC (odds ratio [OR] = 2.12, 95% Cl 1.02-4.42), having knowledge of the importance IC (OR=3.63 Cl, 1.74-7.70), being knowledge about components of IC, being knowledge about common infection from unsafe needle, having heard of IC guidelines (OR=5.94 Cl, 2.38-14.84), having a copy of IC guidelines in the health facility (OR=2.49 Cl, 1.00-6.11), always following IC guidelines (OR=4.16.07 Cl, 1.65-10.5), having received in-service training on IC (OR=2307 Cl, 1.12-5.00), always using soap when washing hand (OR=3.84 Cl, 1.86-7.96) and always wearing protective gear when handling patients (OR=2.09 Cl, 1.03-4.23), availability of supplies needed for infection control. Conclusions and Recommendations A good proportion of the HCW had substantial knowledge about most of the IC measures. Most HCW workers showed favourable attitude towards implementation of IC measures and therefore could not be regarded as a factor that significantly influenced compliance with the measures. Despite good knowledge and favourable attitude towards implementation of IC measures, some of the IC practices were not adequately adhered to. Inadequate availability of supplies had a significant negative impact on compliance with IC measures. Absence of IC committees had a negative impact on compliance with IC measures. This study recommends that in order to improve compliance with IC measures there is need for the District Health Team to: ensure that HCW get refresher training throughout their careers in the basics of IC in order to increase compliance with IC measures; make initiatives geared toward IC by focusing on availability of resources, equipment and supplies; ensure health facility administration form or revive IC committees and are functional; ensure Ministry of Health supplies sufficient copies of IC guidelines in all health facilities in the district. The study recommends that a similar study be carried out in a setting (private health facilities or regional referral hospital) that differs from the study area. Further areas of study include establishing the role of the patients and their attendants in implementation of IC measures in health facilities.
The Influence of Domestic Violence on Household Income and Livelihoods:
(International Health Sciences University., 2013-09) Opio, Eugene Bosco
The study: “The influence of domestic violence on household income and livelihoods.” set out to establish the link between domestic violence, household income and livelihoods of the people of Adyel Division, Lira Municipality. Specifically, it established the manifestations of domestic violence among the people living in Adyel Division, determined the prevalence of domestic violence among households, established household income and livelihood avenues that were affected by domestic violence and identify the linkages between domestic violence and household income. It was a non–experimental, cross-sectional study that employed both qualitative and quantitative data collection tools. The sample size of 422 respondents was involved. A multi-stage sampling procedure was adopted and was carried out in two stages. The quantitative data from the questionnaire and the checklist were cleaned; field edited and entered in the Statistical Package for Social Scientist (SPSS) for Windows version 17.0 software for analysis. Analysis was done using frequency tables and figures. Relevant tests including T-tests and Spearman’s tests were performed as necessary. Primary data was gathered from the research tools and was both quantitative and qualitative in nature. Quantitative data was got from the respondents’ questionnaire while the qualitative data was got from Key Informant Interviews. Secondary data was got from review of existing literature. There were strong linkages between domestic violence, households’ income and livelihoods. Key findings were as follows: the community in Adyel Division was knowledgeable about domestic violence; domestic violence was more prevalent among the married; the major causes of domestic violence in Adyel Division were unfaithfulness/extramarital affairs, and alcoholism or over drinking; there was an inversely proportional relationship between domestic violence and household income (household income reduced with increasing domestic violence) as seen from spouses hindering each other from working. The study made the following recommendations: local authorities together with the welfare department and the Local council offices come up with a comprehensive sensitization program to educate the community the on the value of married partners being faithful, the meaning and implications of domestic violence. Also the local authorities come up with bye-laws regulating the consumption of alcohol and ensure that these laws are enforced and the Uganda Police Force should become vigilant when women or men complain to them and deal with the offenders’ accordingly. Emerging areas for further inquiry or investigation were: the link between public health and livelihood choices at household level; and the influence of repeat domestic violence on spousal health; household leadership and success in small and medium enterprise, Household cohesion and improved livelihoods
The Influence of Rehabilitation Programs on Inmate Formation :
(International Health Sciences University, 2012-09) Kabakoyo, Belinda Roanah
The study entitled: “The Influence of Rehabilitation Programs on inmate formation.” was conducted at the Luzira Women’s and Murchison bay Prisons. The general objective of the study was: to establish the influence of rehabilitation program on inmate formation in Luzira Prisons. Specifically, four objectives defined the lines of inquiry: to identify the rehabilitation programs offered to the inmates in Luzira Prisons; to determine the proportion of inmate formation and to establish the relationship between rehabilitation programs inmate formation. The cross-sectional descriptive design employed a questionnaire, key informant interview guide and observation tools to collect data that was analyzed using STATA package. A homogeneous sample size of 247 convicted respondents enrolled for and attending the programs consented and participated in the study. The study was successful in meeting the study objectives. The key findings were; educational, social, psychological, vocational, honor and theological rehabilitation programs were offered in the prisons. Of the programs offered to the inmates at Luzira prisons some were reported to be more punitive than rehabilitative. The proportion of inmates that underwent formation was 15.38%. There was a statistically significant relationship between the educational, social and vocational rehabilitation programs and an insignificant relationship between the theological and honor rehabilitation programs. The study concluded that inmate rehabilitation and formation was a complex and multi-dimensional process involving various factors. To reduce criminal behavior and improve inmates’ formation, it was necessary to improve quality of rehabilitation programs to meet the needs of the inmates and improve the prison environment. The major recommendations of the study included deliberate inclusion of rehabilitation and the programs as a goal of imprisonment at the policy level and in the constitution of Uganda and deliberate inclusion of the inmates’ choice in the program enrollment procedure. The study suggested imprisonment and disability among other areas for further study.
Injury Morbidity Patterns, Risk Factors and Facilities Attended After Injury in Makindye Division Kampala
(International Health Sciences University, 2011-08) Aboka, Willy Were
Background: There is paucity of injury-related data in Uganda. We conducted a population-based survey on injuries in Namuwongo suburb of Kampala. Objectives: We assessed the patterns of injuries that were sustained among Namuwongo communities between April and September of 2011, the associated factors and facilities that were attended for care. Methods: In a cross-sectional survey quantitative data from 144 households were collected using a questionnaire. Qualitative data were collected by focus group discussions in 3 of 6 participating zones and key informant interviews with community leaders and health facility managers. Results: Ninety-three injuries were reported among 653 subjects in 6 months. Major causes of injuries were road traffic accidents—RTA (24%), cuts (22%) and falls (17%). The mean age of injured people was 33 years (S.D. 12, range 0-67 years), males were more likely to get injured than females (OR: 1.69 CI: 1.05-2.7). 22% of subjects who reported injuries were housewives, 20% were students and 12% were motorcycle riders. Most injuries occurred in the home (54%), roads (27%) and schools (7%). Only 4% of subjects who sought care reported to the local public health facility; 96% sought care at private clinics and hospitals. There were no community-based injury services. Conclusions: RTA, falls and cuts were the commonest injury causes. Males and some occupations were more affected than others. Kampala City Authority needs to improve injury care services at peripheral units and in communities. A division-wide injury survey including cost analysis would inform policy development and advocacy for injury services. Number of words: 249. Key words: Injuries, Population-based, Uganda
Performance of Community Health Insurance Schemes in Uganda:
(International Health Sciences University., 2013-09) Namuyomba, Rashida
Introduction: This study sought to determine factors influencing performance of CHI in central Uganda. This was against the background that health is a fundamental human right but Uganda's health sector is facing challenges of financing, and interventions suggested include community health insurance to ensure access to health care by the most vulnerable populations. CHI schemes have been established in some areas in Uganda but there has been little or no growth of the schemes and some have virtually failed and despite its promotion in Uganda, overall membership has remained low which indicate failure to attract the sufficient number of people for their sustainability. This calls for determining factors which influence performance of the intervention. The study examined aspects of CHI schemes and that is the management aspects, the extent of coverage, economic factors and acceptability which made up the specific objectives. Methodology: A cross-sectional survey was the study design adopted. Using a case study of Luwero, Nakaseke and Nakasongola districts in Central Uganda, quantitative and qualitative approaches were engaged to conduct the study. Data was collected through a household survey involving 401 households, in-depth interviews with Key Informants and secondary sources. Quantitative–descriptive and thematic analysis was undertaken. Results: The findings indicate that the self management model, high level of community participation, the inclusive benefits package, household enrolment, awareness and positive perception are the identified key strengths of the schemes. The key weaknesses of CHI identified are, lack of a legal framework, inadequate management capacity, lack of subsidies, high cost of premium associated with wide spread poverty and inadequate knowledge of scheme components. There are also no strategies to include the most vulnerable populations in CHI. Conclusion and recommendation: The study concludes that amidst these obstacles, CHI is an intervention worth pursuing due to its benefits to rural households and recommendations suggested are improved management of the schemes, a policy framework, provision of subsidies and support to CHI to ensure sustainability of the intervention.

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