Master of Science in Health Services Management

Evaluate the implementation process and effect of performance based financing in the health centers of Jinja diocese: case study centers of Jinja diocese

2011-08-01T00:00:00Z

Evaluate the implementation process and effect of performance based financing in the health centers of Jinja diocese: case study centers of Jinja diocese Buuka, Godfrey Zziwa Most of the low and medium income countries are far below their targets as regards the health related Millennium Development Goal and it will be impossible for them to meet their targets by 2015 (World Bank 2008, WHO 2010). In 2005, a concept of universal access to health for all by 2025 was coined by WHO member countries (WHO 2005). This desire for attainment of universal health for all has led to an increased financial support to the developing countries, unfortunately their health care indicators remain poor and their performance does not match with the amount of resources they have received. WHO has asked all stakeholders to look out for ways in which they can stimulate improved performance in health with a view of reaching more people with acceptable quality services (WHO 2010). Performance Based Financing (PBF) has slowly gained ground as one of the provider payment mechanisms that can address the inefficiencies in health. It is being implemented in several countries and experience about its effect on healthcare delivery is building up. A pilot PBF project is being implemented in the health centers of Jinja diocese. However, there is no information about its implementation and what effects it can have on healthcare service delivery in Jinja diocese. Therefore this study was intended to evaluate the implementation process of the PBF project, its effect on the performance of health centers as well as the benefits and challenges faced during the implementation. It was a comparative, descriptive cross sectional study. The study involved interviewing key respondents about the implementation process, the benefits and challenges they were experiencing in the process. Performance data was also collected from the health centers for 2 vi years before and 2 years following PBF introduction. Same data was collected for the same period of time from public health centers that are not involved in PBF. Comparison was then made so as to assess the possible effect of PBF on the performance of the H/Cs. The finding showed that the parallel model of PBF implementation was used within the thin structures in the diocese. There was no creation of new institutional entities that have been accepted as being necessary for the success of PBF. The study noted a positive trend in performance in most of the health centers implementing PBF in comparison with the public health centers but it was very difficult to truly attribute this observation to PBF especially in the absence of the basic institutions to support the implementation process. Some of the benefits the study noted included improved attention to recording and timely submission of facility reports, patient centered facility planning, lowering and flattening of user fee in order to attract more patients to come for the services. While challenges included; understaffing, rising cost of supplies in a wake of desire for the H/Cs to lower user fees, difficult performance targets to attain among others. It was therefore concluded that despite the observed increase in performance of the H/Cs, there is need to streamline the implementation process by creating autonomous entities of local fund holder/steering committee, regulator and verifier. This will give credibility to the process especially when there is a desire to scale up the approach from a small pilot project to a wider coverage involving even the public health sector. Anguyo Robert; Anguyo Robert

Determinants of health institutional delivery among mothers attending immunization services in Busia district a cross- sectional study

2020-11-19T00:00:00Z

Determinants of health institutional delivery among mothers attending immunization services in Busia district a cross- sectional study Ojok, Ritara Vincent Both maternal and neonatal health outcomes improve when skilled personnel provide delivery services within health facilities. Determinants of delivery location are crucial to promoting health facility deliveries and yet health facility delivery rates remain low in most low- and middle- income countries. It is asserted that there is expert consensus that delivery at a health facility substantially reduces the risk of maternal death. They argued that by increasing the use of antenatal care (ANC), postnatal care (PNC) and family planning, the risk of maternal death can be further reduced. Several factors influence the location where women deliver from. Such factors include place of residence, family decision-making regarding place of delivery, ANC attendance, socioeconomic status (SES), trimester of pregnancy, age of woman, parity, transport, placenta disposal, delivery position, complication at last delivery, age of pregnancy, levels of education of the woman and her partner, and valid health insurance. All these tend to be closely related to the context. In eastern region of Uganda, examining such factors could help in improving institutional deliveries. The main objective of this study was to ascertain the determinants of institutional health facility delivery among mothers attending immunization services in Busia district. Methodology: A cross-sectional analytical design, both qualitative and quantitative was used. A sample of 385respondent mothers were interviewed using semi-structured questionnaire. Two focus group discussions (FGDs) each composed of 8 to 12 members were held with mothers. Data was analyzed using SPSS version 25. Ethical considerations in research, obtaining letter of introduction for data collection, clearance from university, and quality controls were well taken care of. The level of institution health facility delivery was good, mothers attending immunization services (post-natal visits)) were asked to state whether or not they deliver in health facility, up to 318( 82.6%) delivered in health facilities, with most of the mothers delivering from government hospitals (50.9%) followed by private hospitals (14.3%). The study found that place of residence of the mothers was associated with health facility delivery (X2 (1) =1.515, p<0.002). Mothers who lived in urban settings were 2.7times more likely to deliver from health facilities than mothers who lived in rural settings [COR=2.686, 95% CI (0.394-1.194)]. Husband’s educational level was found to be a determinant of health facility delivery (X2 (3) =2.054, p<0.006). In comparison with mothers whose husbands had no education, mothers whose husbands had primary education, secondary education and tertiary education were 2.2times (COR=2.249, 95% CI(0.581-8.698)), 1.5times (COR=1.546, 95% CI(0.537-4.453)) and 1.3times (COR=1.329, 95% CI (0.501-3.523)) more likely to deliver from health facility respectively. History of having ever delivered from a health facility was associated with the recent health facility delivery (X2 (1) = 0.076, p<0.007). Similarly, getting partner support for health facility delivery was a determinant for health facility delivery (p<0.003). Nanying Miisa; Nanying Miisa

Performance accountability, evaluation of performance by health care providers in Bugisu region

2014-09-01T00:00:00Z

Performance accountability, evaluation of performance by health care providers in Bugisu region Muiri, Mupalya Gidale There have been hostile press reports and comments from prominent political leaders about the poor and unethical performance of health service providers and the system as a whole. This prompted this study that set out to establish whether the health providers measured their performance, and whether they accounted to the stakeholders, whether the stakeholders took remedial action and if all that was done then what factors were influencing performance accountability that it was not delivering the desired result. The study took place in three districts of Bugisu region, purposively sampled and these were Bududa, Bulambuli and Mbale. Each district was divided into geographical zones. From each zone a health centre (HC) II and a HC III were sampled randomly using table of random numbers. The district Local Council V (LC V) chairmen, secretary health and chairperson health committee were interviewed using a prepared questionnaire, The same questionnaire was administered to the Chief Administrative Officers (CAO), District Health Officers (DHO) and Assistant district health officers (ADHO). For every randomly selected facility the corresponding Local Council (LC) III chairman, secretary health and chairperson health committee were also interviewed. The same questionnaire was administered to the facility in charge. A different questionnaire was administered to two Health Unit management committee (HUMC) members that were not health workers. A check list was also filled for each sampled facility. General hospitals and Health centre IV were purposively sampled and a questionnaire administered to the in charge and senior nursing officer, a check list was also administered. The findings showed that there was performance accountability provided to stakeholders by the service providers and the stakeholders read and understood the accountable and took action to remedy the situation. However it was also established the failures arose because of inadequate funding and inequitable resource allocation from the centre. Katongole Simon Peter; Katongole Simon Peter

Contribution of performance management processes to health facility performance outputs in Namayingo district

2015-10-01T00:00:00Z

Contribution of performance management processes to health facility performance outputs in Namayingo district Ouma, Fredrick Performance management system was introduced by the Ministry of public of Uganda in 2007. It was rolled out in the health sector by the Uganda Capacity Programme (UCP) with the goal of improving performance through enhancement of management of an individual’s performance. Whereas some health facilities have better health facility performance outputs, others experience poor health facility performance outputs. The purpose of this study was to establish the contributions of performance management processes to health facility performance outputs. The study was cross sectional, employing both qualitative and quantitative approaches. In qualitative design, facility managers of H/C III and H/C IV were interviewed and the responses recorded with audio recorder as well as documentation on paper. Quantitative approach involved use of researcher developed self-administered questionnaire given to health workers at the selected health centre IV, III and IIs. Data were analyzed with descriptive and analytical statistical tests. Health centre IV and IIIs conduct performance planning, planning reviewing, performance feedback, performance appraisal and performance rewarding (performance management processes) though poorly. Health facilities implementing performance management processes were performing better than those without. Most health facilities had high standard unit of output and the staff productivity at health centre IIs was higher than at health centre IIIs. A Correlation of performance appraisal with standard unit of out showed no significant relationship. The study findings revealed that other factors influencing health facility performance apart from performance management were; leadership and management, medical supplies, understaffing. Performance management processes are implemented poorly at selected health facilities. The facilities showed a performance disparity as reflected by the standard unit of output. There was knowledge gap among the facility managers in the context of performance management that needs attention if the performance of the facilities is to be revamped. Staffing and improvement in working conditions should be given attention. Recommendations: Facility managers should be supported by District Health Officer (DHO) for training in performance management/ improvement, strengthen use of Health Management Information Systems (HMIS) data at health facilities; improve on staffing and working conditions. Mugisha John Francis; Mugisha John Francis