Access to and utilisation of health services for the poor in Uganda: a systematic review of available evidence

Kiwanuka, Suzanne N; Ekirapa, Elizabeth; Peterson, Stefan; Okui, Olico; Rahman, Md. Hafizur; Peters, David H.; Pariyo, George

doi:10.1016/j.trstmh.2008.04.023

Cited by 218 publications

(241 citation statements)

References 22 publications

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“…In these communities, lack of money for transportation and payment for other health-related costs is one of the reasons that lead to underutilization of maternal and newborn services [4,31]. This article explores the possibility of using CBSGs in increasing birth preparedness in rural communities of Uganda.…”

Section: Paper Contextmentioning

confidence: 99%

Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services

Mutebi

Kananura

Ekirapa-Kiracho

et al. 2017

Global Health Action

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Background: Rural populations in Uganda have limited access to formal financial Institutions, but a growing majority belong to saving groups. These saving groups could have the potential to improve household income and access to health services. Objective: To understand organizational characteristics, benefits and challenges, of savings groups in rural Uganda. Methods: This was a cross-sectional descriptive study that employed both quantitative and qualitative data collection techniques. Data on the characteristics of community-based savings groups (CBSGs) were collected from 247 CBSG leaders in the districts of Kamuli, Kibukuand Pallisa using self-administered open-ended questionnaires. To triangulate the findings, we conducted in-depth interviews with seven CBSG leaders. Descriptive quantitative and content analysis for qualitative data was undertaken respectively. Results: Almost a quarter of the savings groups had 5–14 members and slightly more than half of the saving groups had 15–30 members. Ninety-three percent of the CBSGs indicated electing their management committees democratically to select the group leaders and held meetings at least once a week. Eighty-nine percent of the CBSGs had used metallic boxes to keep their money, while 10% of the CBSGs kept their money using mobile money and banks,respectively. The main reasons for the formation of CBSGs were to increase household income, developing the community and saving for emergencies. The most common challenges associated with CBSG management included high illiteracy (35%) among the leaders,irregular attendance of meetings (22%), and lack of training on management and leadership(19%). The qualitative findings agreed with the quantitative findings and served to triangulate the main results. Conclusions: Saving groups in Uganda have the basic required structures; however, challenges exist in relation to training and management of the groups and their assets. The government and development partners should work together to provide technical support to the groups.

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Section: Paper Contextmentioning

confidence: 99%

Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services

Mutebi

Kananura

Ekirapa-Kiracho

et al. 2017

Global Health Action

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“…Although we have not yet replicated these analyses in other regions, it is possible that limited access to health services may lead to similar patterns in other geographic regions. Evidence suggests that barriers to access related to travel time, distance, and cost are ubiquitous in developing countries (15,16). However, there are also other factors, such as care-seeking behaviors, socioeconomic status, and population density, which determine which subpopulations are at higher risk for disease (17).…”

Section: Discussionmentioning

confidence: 99%

Distance to health services affects local-level vaccine efficacy for pneumococcal conjugate vaccine (PCV) among rural Filipino children

Root

Lucero

Nohynek

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

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Pneumococcal conjugate vaccines (PCVs) have demonstrated efficacy against childhood pneumococcal disease in several regions globally. We demonstrate how spatial epidemiological analysis of a PCV trial can assist in developing vaccination strategies that target specific geographic subpopulations at greater risk for pneumococcal pneumonia. We conducted a secondary analysis of a randomized, placebo-controlled, double-blind vaccine trial that examined the efficacy of an 11-valent PCV among children less than 2 y of age in Bohol, Philippines. Trial data were linked to the residential location of each participant using a geographic information system. We use spatial interpolation methods to create smoothed surface maps of vaccination rates and local-level vaccine efficacy across the study area. We then measure the relationship between distance to the main study hospital and local-level vaccine efficacy, controlling for ecological factors, using spatial autoregressive models with spatial autoregressive disturbances. We find a significant amount of spatial variation in vaccination rates across the study area. For the primary study endpoint vaccine efficacy increased with distance from the main study hospital from −14% for children living less than 1.5 km from Bohol Regional Hospital (BRH) to 55% for children living greater than 8.5 km from BRH. Spatial regression models indicated that after adjustment for ecological factors, distance to the main study hospital was positively related to vaccine efficacy, increasing at a rate of 4.5% per kilometer distance. Because areas with poor access to care have significantly higher VE, targeted vaccination of children in these areas might allow for a more effective implementation of global programs.spatial epidemiology | spatial analysis | targeted intervention | randomized controlled trial | GIS

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“…Failure to access skilled delivery care services has been linked to three main delays – delay in seeking care, delay in reaching care and delay in receiving appropriate care [3]. Access to cash is one of the factors that contribute to these delays [4–6]. Therefore, households are often encouraged to prepare for birth by saving money that can be used during pregnancy and at the time of birth [7,8].…”

Section: Introductionmentioning

confidence: 99%

‘Nurture the sprouting bud; do not uproot it’. Using saving groups to save for maternal and newborn health: lessons from rural Eastern Uganda

Ekirapa-Kiracho

Paina

Kananura

et al. 2017

Global Health Action

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Background: Saving groups are increasingly being used to save in many developing countries. However, there is limited literature about how they can be exploited to improve maternal and newborn health. Objectives: This paper describes saving practices, factors that encourage and constrain saving with saving groups, and lessons learnt while supporting communities to save through saving groups. Methods: This qualitative study was done in three districts in Eastern Uganda. Saving groups were identified and provided with support to enhance members’ access to maternal and newborn health. Fifteen focus group discussions (FGDs) and 18 key informant interviews (KIIs) were conducted to elicit members’ views about saving practices. Document review was undertaken to identify key lessons for supporting saving groups. Qualitative data are presented thematically. Results: Awareness of the importance of saving, safe custody of money saved, flexible saving arrangements and easy access to loans for personal needs including transport during obstetric emergencies increased willingness to save with saving groups. Saving groups therefore provided a safety net for the poor during emergencies. Poor management of saving groups and detrimental economic practices like gambling constrained saving. Efficient running of saving groups requires that they have a clear management structure, which is legally registered with relevant authorities and that it is governed by a constitution. Conclusions: Saving groups were considered a useful form of saving that enabled easy acess to cash for birth preparedness and transportation during emergencies. They are like ‘a sprouting bud that needs to be nurtured rather than uprooted’, as they appear to have the potential to act as a safety net for poor communities that have no health insurance. Local governments should therefore strengthen the management capacity of saving groups so as to ensure their efficient running through partnerships with non-governmental organizations that can provide support to such groups.

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Access to and utilisation of health services for the poor in Uganda: a systematic review of available evidence

Cited by 218 publications

References 22 publications

Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services

Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services

Distance to health services affects local-level vaccine efficacy for pneumococcal conjugate vaccine (PCV) among rural Filipino children

‘Nurture the sprouting bud; do not uproot it’. Using saving groups to save for maternal and newborn health: lessons from rural Eastern Uganda

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