Factors influencing utilisation of government firstline health facilities in Kampala City Council, Kampala district

Abstract

INTRODUCTION: Health facilities were constructed in peripheral areas of kampala generally to provide services to people who live in these areas. The main aim was to de-congest the national referral hospital mulago and other major hospitals in the district. This followed a study done in kawempe division which identified need to establish health facilities in the periphery of kampala to serve the urban poor communities. OBJECTIVE: The study aimed at identifying the factors influencing their utilization so that evidence based interventions can be planned to improve service utilization. Specifically, to establish the utilization levels of the health units, to establish the people’s attitudes towards the health units and assess community awareness on services offered by KCC health facilities. METHODOLOGY: This study was a cross-sectional study using both qualitative and quantitative data collection methods. The study populations were members of households, health workers and community leaders in their catchments areas. Data was collected using structured and semi-structured questionnaires. FGDs and key informant interview guides were used to collect qualitative data. Eight FGDs and eight key informants interviews were conducted. A total of 320 households were sampled and surveyed. Quantitative data was analyzed using Epi-Info 2002 computer program, while the qualitative data was analyzed manually using master sheet. RESULTS: Majority of respondents were females (75.6%), 77.8% of the respondents were married and the mean age of the respondents was 32 years. Among the respondents interviewed 88 (27.5%) had never used the nearest KCC health facility and out of 235 people who became sick in six months prior to this study, only 144 (61.5%) had sought healthcare services from the nearest KCC health facility The main reasons why people did not utilize KCC health facilities were; fear for long waiting time, fear of overcrowding at KCC health units and shortage of drugs. Similar issues were raised from FGDs A and KIs interviews. Majority of the respondents (185) preferred to use nearest KCC health facilities if the services were normalized. CONCLUSIONS: The utilization rate of government KCC first line health facilities is at 0.45 per person per six months or 0.90 per person per year. Almost everybody in Kampala utilizes healthcare facility when sick or has sick person. The common disease conditions in Kampala are malaria (fever) and acute respiratory tract infections. The main reasons why some people did not utilize the KCC health facilities are fear of long waiting time, shortage of drugs and lack of some services like laboratory facilities. RECOMMENDATIONS: Health facility in-charges should introduce appointment system for re-visit clients with chronic conditions so that they reduce on number of re-attendances. Targeted support supervision should be done so as to improve health worker-client relationship. Health facility in-charges should introduce triage system so that patients who are very sick can be seen quickly by other health workers. The DHT should organise training workshops on drug quantification and procurement for the health unit in-charges. More sensitization through health education activities to the communities in the catchment’s areas of these health facilities should be done. There is need to do re-deployment of health care workers while putting level of the health facility and services offered into consideration.