BackgroundA case study was prepared examining government resource contributions (GRCs) to private-not-for-profit (PNFP) providers in Uganda. It focuses on Primary Health Care (PHC) grants to the largest non-profit provider network, the Uganda Catholic Medical Bureau (UCMB), from 1997 to 2015. The framework of complex adaptive systems was used to explain changes in resource contributions and the relationship between the Government and UCMB.MethodsDocuments and key informant interviews with the important actors provided the main sources of qualitative data. Trends for GRCs and service outputs for the study period were constructed from existing databases used to monitor service inputs and outputs. The case study’s findings were validated during two meetings with a broad set of stakeholders.ResultsThree major phases were identified in the evolution of GRCs and the relationship between the Government and UCMB: 1) Initiation, 2) Rapid increase in GRCs, and 3) Declining GRCs. The main factors affecting the relationship’s evolution were: 1) Financial deficits at PNFP facilities, 2) advocacy by PNFP network leaders, 3) changes in the government financial resource envelope, 4) variations in the “good will” of government actors, and 5) changes in donor funding modalities. Responses to the above dynamics included changes in user fees, operational costs of PNFPs, and government expectations of UCMB. Quantitative findings showed a progressive increase in service outputs despite the declining value of GRCs during the study period.ConclusionsGRCs in Uganda have evolved influenced by various factors and the complex interactions between government and PNFPs. The Universal Health Coverage (UHC) agenda should pay attention to these factors and their interactions when shaping how governments work with PNFPs to advance UHC. GRCs could be leveraged to mitigate the financial burden on communities served by PNFPs. Governments seeking to advance UHC goals should explore policies to expand GRCs and other modalities to subsidize the operational costs of PNFPs.
Background Sepsis is the leading cause of death in children under five in low-and middle-income countries. The rapid identification of the sickest children and timely antibiotic administration may improve outcomes. We developed and implemented a digital triage platform to rapidly identify critically ill children to facilitate timely intravenous antibiotic administration. Objective This quality improvement initiative sought to reduce the time to antibiotic administration at a dedicated children's hospital outpatient department in Mbarara, Uganda. Intervention and study design The digital platform consisted of a mobile application that collects clinical signs, symptoms, and vital signs to prioritize children through a combination of emergency triggers and predictive risk algorithms. A computer-based dashboard enabled the prioritization of children by displaying an overview of all children and their triage categories. We evaluated the impact of the digital triage platform over an 11-week pre-implementation phase and an 11-week postimplementation phase. The time from the end of triage to antibiotic administration was compared to evaluate the quality improvement initiative. Results There was a difference of-11 minutes (95% CI,-16.0 to-6.0; p < 0.001; Mann-Whitney U test) in time to antibiotics, from 51 minutes (IQR, 27.0-94.0) pre-implementation to 44 minutes (IQR, 19.0-74.0) post-implementation. Children prioritized as emergency received the greatest time benefit (-34 minutes; 95% CI,-9.0 to-58.0; p < 0.001; Mann-Whitney U test).
Recognizing the health impact of timing and spacing pregnancies, the Sustainable Development Goals call for increased access to family planning globally. While faith-based organizations in Africa provide a significant proportion of health services, family planning service delivery has been limited. This evaluation seeks to assess the effectiveness of implementing a systems approach in strengthening the capacity of Christian Health Associations to provide family planning and increase uptake in their communities.From January 2014 to September 2015, the capacity of three Christian Health Associations in East Africa-Caritas Rwanda, Uganda Catholic Medical Bureau, and Uganda Protestant Medical Bureau-was strengthened with the aims of improving access to women with unmet need and harmonizing faith-based service delivery contributions with their national family planning programs. The key components of this systems approach to family planning included training, supervision, commodity availability, family planning promotion, data collection, and creating a supportive environment. Community-based provision of family planning, including fertility awareness methods, was introduced across intervention sites for the first time. Five hundred forty-seven facility-and community-based providers were trained in family planning, and 393,964 people were reached with family planning information. Uptake of family planning grew substantially in Year 1 (12,691) and Year 2 (19,485) across all Christian Health Associations as compared to the baseline year (3,551). Cumulatively, 32,176 clients took up a method during the intervention, and 43 percent of clients received this service at the community level. According to a provider competency checklist, facility-and community-based providers were able to adequately counsel clients on new fertility awareness methods. Integration of Christian Health Associations into the national family planning strategy improved through participation in routine technical working group meetings, and the Ministries of Health in Rwanda and Uganda recognized them as credible family planning partners. Findings suggest that by strengthening capacity using a systems approach, Christian Health Associations can meaningfully contribute to national and international family planning goals. Increased attention to community-based family planning provision and to mainstreaming family planning service delivery across Christian Health Associations is recommended.
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