Older persons report poor health status and greater need for healthcare. However, there is limited research on older persons’ healthcare disparities in Uganda. This paper reports on factors associated with older persons’ healthcare access in Uganda, using a nationally representative sample. The authors conducted secondary analysis of data from a sample of 1602 older persons who reported being sick in the last 30 days preceding the Uganda National Household Survey. They used frequency distributions for descriptive data analysis and chi-square tests to identify initial associations and fit generalised linear models (GLM) with the poisson family and the log link function, to obtain incidence risk ratios (RR) of accessing healthcare in the last 30 days, by older persons in Uganda. More than three quarters (76%) of the older persons accessed healthcare in the last 30 days. Access to healthcare in the last 30 days was reduced for older persons from poor households; and with some or with a lot of walking difficulty. Conversely, accessing healthcare in the last 30 days for older persons increased for those who earned wages and missed work due to illness for 1–7 and 8–14 days. In addition, those who reported non-communicable diseases (NCDs) such as heart disease, hypertension or diabetes were more likely to access healthcare during the last 30 days. In the Ugandan context, health need factors (self-reported NCDs, severity of illness and mobility limitations) and enabling factors (household wealth status and earning wages in particular) were the most important determinants of accessing healthcare in the last 30 days among older persons.
Equitable health services
In this paper, using in-depth case studies of Ghanaian and Cameroonian responses, the authors discuss the challenge of developing effective primary and secondary prevention to tackle chronic diseases such as stroke, hypertension, diabetes and cancers. They observe fundamental differences between Ghana and Cameroon in terms of "multi-institutional and multi-faceted responses" to chronic diseases. Whereas Ghana does not have a chronic disease policy, the authors note that it has a national health insurance policy that covers drug treatment of some chronic diseases, a culture of patient advocacy for a broad range of chronic conditions and mass media involvement in chronic disease education. On the other hand, the authors note that Cameroon has a policy on diabetes and hypertension as well as established diabetes clinics across the country and provides training to health workers to improve treatment and education despit lack of community and media engagement. In both countries churches provide public education on major chronic diseases, but neither country has conducted systematic evaluation of the impact of interventions on health outcomes and cost-effectiveness. In conclusion, the authors recommend a comprehensive and integrative approach to chronic disease intervention that combines structural, community and individual strategies. To this end, they outline research and practice gaps and best practice models within and outside Africa that can instruct the development of future interventions.
Traditionally, standards of care have been developed by a panel of experts and then implemented by a multidisciplinary team. This paper considered the feasibility of involving health professionals of all grades and policymakers in the establishment of standards for postpartum hemorrhage (PPH) in Malawi. The team established these standards using evidence from Malawi national guidelines and World Health Organization (WHO) manuals. They agreed on ten objectives and developed the structure, process, and outcome for each objective. The standards addressed different aspects of prevention, diagnosis and treatment. The involvement of both health professionals and policymakers might promote ownership, sustainability and allocation of resources for implementation.
This study investigated the development of a hypertension heath literacy assessment tool to establish patients’ comprehension of the health education they receive in primary healthcare clinics in Tshwane, Gauteng, South Africa. The design was quantitative, descriptive and contextual. The study population comprised health promoters who were experts in the field of health, documents containing hypertension health education content and individuals with hypertension. The tool was administered to 195 participants concurrently with a learning ability battery. The health literacy assessment tool was found to be a valid tool that can be used in busy primary healthcare clinics as it takes less than two minutes to administer. This tool can inform the healthcare worker on the depth of hypertension health education to be given to the patient, empowering the patient and saving time in primary healthcare facilities.
Diabetes is a growing problem in Africa and will continue to be so, as a high risk of diabetes is tied to highly active retroviral therapy for AIDS. Data for diabetes in Africa is small, as the subject has received little attention, and many of the African studies have not been published in Western, peer-reviewed journals. This paper highlights many of the issues surrounding diabetes treatment in Africa.
This study analysed factors affecting variations in the observed quality of antenatal and sick-child care in primary-care facilities in seven African countries. The authors pooled nationally representative data from service provision assessment surveys of health facilities in Kenya, Malawi, Namibia, Rwanda, Senegal, Uganda and the United Republic of Tanzania (survey year range: 2006-2014). Based on World Health Organisation protocols, the authors created indices of process quality for antenatal care (first visits) and for sick-child visits. The authors assessed national, facility, provider and patient factors that might explain variations in quality of care, using separate multilevel regression models of quality for each service. Data were available for 2594 and 11 402 observations of clinical consultations for antenatal care and sick children, respectively. Overall, health-care providers performed a mean of 62.2% of eight recommended antenatal care actions and 54.5% of nine sick-child care actions at observed visits. Quality of antenatal care was higher in better-staffed and -equipped facilities and lower for physicians and clinical officers than nurses. Experienced providers and those in better-managed facilities provided higher quality sick-child care, with no differences between physicians and nurses or between better- and less-equipped clinics. Private facilities outperformed public facilities. Country differences were more influential in explaining variance in quality than all other factors combined. The quality of two essential primary-care services for women and children was weak and varied across and within the countries. Analysis of reasons for variations in quality could identify strategies for improving care.
While previous studies have assessed the impact of single conditions on absenteeism, the current study evaluates multiple health factors associated with absenteeism in a large worker population across several sectors in Namibia. From March 2009 to June 2010, a series of cross-sectional surveys of 7,666 employees in seven sectors of industry were conducted in Namibia. Results indicated that, controlling for demographic and job-related factors, high blood glucose and diabetes had the largest effect on absenteeism, followed by anemia and being HIV positive. In addition, working in the fishing or services sectors was associated with an increased incidence of sick days. The highest prevalence of diabetes was in the services sector, with the highest prevalence of HIV in the fishing sector. The authors conclude that both non-communicable disease risk factors and infectious diseases are associated with increased rates of short-term absenteeism of formal sector employees in Namibia. Programmes to manage these conditions could help employers avoid costs associated with absenteeism, they recommend, which could include basic health care insurance including regular wellness screenings.
Early recognition of symptoms and signs perceived as malaria are important for effective case management, as few laboratories are available at peripheral health facilities. The validity and reliability of clinical signs and symptoms used by health workers to diagnose malaria were assessed in an area of low transmission in south-western Uganda.
This is a comparative case study of the early management of ART scale up in three South African provincial governments – Western Cape, Gauteng and Free State – focusing on both operational and strategic dimensions. Drawing on surveys of models of ART care and analyses of the policy process conducted in the three provinces between 2005 and 2007, as well as a considerable body of grey and indexed literature on ART scale up in South Africa, it draws links between implementation processes and variations in provincial ART coverage (low, medium and high) achieved in the three provinces. While they adopted similar chronic disease care approaches, the study found that the provinces differed with respect to political and managerial leadership of the programme, programme design, the balance between central standardisation and local flexibility, the effectiveness of monitoring and evaluation systems, and the nature and extent of external support and programme partnerships. This case study points to the importance of sub-national programme processes and the influence of factors other than financing or human resource capacity, in understanding intervention scale up.
This study explored possible differences in health care seeking behaviour among a rural and urban African population. Four rural and urban SetTswana communities which represented different strata of urbanisation in the North West Province, South Africa, were selected. Structured interviews were held with 206 participants. Data on general demographic and socio-economic characteristics, health status, beliefs about health and (access to) health care was collected. The results illustrated differences in socio-economic characteristics, health status, beliefs about health, and health care utilisation. Inhabitants of urban communities rated their health significantly better than rural participants. Although most urban and rural participants consider their access to health care as sufficient, they still experienced difficulties in receiving the requested care. Rural participants had significantly lower employment and available weekly budget for health care and transport costs. Urban participants were more than 5 times more likely to prefer a medical doctor in private practice.