Health systems readiness to provide geriatric friendly care services in Uganda: a cross-sectional study

Abstract

Background As ageing emerges as the next public health threat in Africa, there is a paucity of information on how prepared its health systems are to provide geriatric friendly care services. In this study, we explored the readiness of Uganda’s public health system to offer geriatric friendly care services in Southern Central Uganda. Methods Four districts with the highest proportion of old persons in Southern Central Uganda were purposively selected, and a cross-section of 18 randomly selected health facilities (HFs) were visited and assessed for availability of critical items deemed important for provision of geriatric friendly services; as derived from World Health Organization’s Age-friendly primary health care centres toolkit. Data was collected using an adapted health facility geriatric assessment tool, entered into Epi-data software and analysed using STATA version 14. Kruskal-Wallis and Dunn’s post hoc tests were conducted to determine any associations between readiness, health facility level, and district. Results The overall readiness index was 16.92 (SD ±4.19) (range 10.8–26.6). This differed across districts; Lwengo 17.91 (SD ±3.15), Rakai 17.63 (SD ±4.55), Bukomansimbi 16.51 (SD ±7.18), Kalungu 13.74 (SD ±2.56) and facility levels; Hospitals 26.62, Health centers four (HCIV) 20.05 and Health centers three (HCIII) 14.80. Low readiness was due to poor scores concerning; leadership (0%), financing (0%), human resources (1.7%) and health management information systems (HMIS) (11.8%) WHO building blocks. Higher-level HFs were statistically significantly friendlier than lower-level HFs (p = 0.015). The difference in readiness between HCIIIs and HCIVs was 2.39 (p = 0.025). Conclusion There is a low readiness for public health facilities to provide geriatric friendly care services in Uganda. This is due to gaps in all of the health system building blocks. There is a need for health system reforms in Uganda to adequately cater for service provision for older adults if the 2020 global healthy ageing goal is to be met.

‘We had to manage what we had on hand, in whatever way we could’: adaptive responses in policy for decentralized drug-resistant tuberculosis care in South Africa

“…For the most part, tools to assess ‘readiness’ for uptake of specific policies or scale-up of existing interventions in LMIC involve mapping essential resources, knowledge and skills needed to implement a new intervention or initiative at facility-level ( WHO 2015 ). While useful in ranking facilities according to their capacity, in principle, to provide basic health services at minimum standards ( Jigjidsuren et al , 2019 ; Ssensamba et al , 2019 ), these tools lack consideration of the software dimensions of ‘readiness’ related to individual and collective agency to implement change.…”

Advancing Age in Africa, the Urgent Need for Institutional Geriatric Care in a Low Resource Setting: A Case Report

“…Despite the surge in numbers of elderly people and the increase in the burden of chronic diseases among the aged, a recent study by Dotchin et al, revealed that, there are few geriatricians in Africa, due to no formal undergraduate/ postgraduate training for medical students in geriatrics [7]. In Uganda, a study by Ssensamba et al, showed a low preparedness of public health facilities to offer geriatric cordial care services due to gaps in the healthcare systems, thereby calling for healthcare reforms to sufficiently cater for service provision for the aged in Uganda [8].…”

Age-Friendly Health Care: A Systematic Review

“…As for other types of health care provision, there are three articles on primary care [49][50][51], one on tertiary care [52], and seven articles that address care integration [53][54][55][56][57][58][59]. It is understood that care integration concerns the promotion of integrated and continuous health care processes in space and time [60].…”

“…In this sense, there was a prevalence of a set of four fields related to the concept of Age-Friendly Hospital-Management policy, Communication, and services, Care processes and Physical Environment-and a set of fields concerning the "Age-Friendly Emergency Department"-Social climate, Policies and procedures, Systems and processes of care, and Physical environment (See Table 1). The most common WHO Principle to these studies (with the exception of [58]) was the "Physical environment", which required the attention of all authors in an exclusive or complementary manner with regard to the application of the guidelines of universal design.…”

“…Classified as second class of conformance, four articles mention the WHO project and use the respective toolkit throughout the study. The articles of Ahmadi et al [40], Woo et al [51], and Ssensamba et al [58] assess the quality of the services provided to the older adult population by conducting interviews and focus groups to staff and administrators, in order to identify the gaps and changes necessary to provide age-friendly health care (Age-Friendly Hospital, Age-Friendly Primary Health Care, and Age-Friendly Health System, respectively). In turn, Alhamdan et al [49] assess the services provided to older adults in primary health care and the ease of use of those services by older adults based on the guidelines of the WHO toolkit regarding two Principles: management systems and physical environment.…”