The determinants of provision of primary health care services in Eastern Uganda

Abstract

The study set out to determine the factors that influence provision of Primary Health Care in Eastern Uganda. The study was mainly guided by two objectives, namely; health facility characteristics which constituted ownership and level (grade) of health facility and limitations of the health system that constituted category of staff, supervision, funding, decision making among others from which also, the social economic and background characteristics of this study was derived. A total of 418 respondents from among health care providers were studied. Of these, 91.1% were from government owned health Units and 8.9% were shared among Non governmental Organizations and religious Institutions. 20.3% of the Health Units were graded as Health Center two, 55% were graded as Health Center three and Health Center four constituted 16.3%. Health Centre II facilities exist at the parish level and are staffed by nurses, and provide outpatient services. The Health Centre III facilities are at the Sub-county level and provide both outpatients as well as inpatient (including maternity) services (8-bed units). At the apex of the district primary heath facilities are the Health Centre IV facilities, which are established at the county level. These are 12-bed facilities with theatre units, headed by a medical officer, and expected to provide a full range of services. This study used data obtained from the 2004 National Service Delivery Survey data set. The data was then analyzed at the univariate level using frequency distributions and at bivariate level, cross tabulations were done to determine the relationships between the dependent and the independent variables. Further more, multivariate analysis was carried out using the binary logistic regression model. At bivariate level, the study found assignificant association between medical waste disposal, category of staff and PHC funds allocated to the provision of Primary Health Care. At multivariate level only support staff and medical supplies stock outs showed a significant association with provision of Primary Health Care. In conclusion, Most of the health units in Eastern Uganda were found to be government owned which meant that access was largely free of charge, with 8.9% Non governmental organizations’ owned facilities supplementing the government efforts to provide primary health care. While at 55%, Health center threes reflected fair coverage of the region, health center twos at 20.3% reflected a very poor coverage in the eastern region of Uganda. The study recommended that Government and the Non Governmental Organizations, since they are largely the providers of Primary Health Care as a service increase funding so that the PHC program can be evenly spread out so as to cover the entire region. The majority of the respondents that is (65.6%) said that funding was not sufficient and yet this impacts on operational ability in terms of facilitation and staff motivation. There should also be further efforts geared towards strengthening the monitoring and supervision system to ensure that Primary Health Care as a service is provided to the communities as desired. This will eliminate malpractices and instances of corruption that can also discourage not only dedicated staff but also the intended beneficiaries.