IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0224215.html
   My bibliography  Save this article

‘We are all serving the same Ugandans’: A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda

Author

Listed:
  • Katherine Albutt
  • Gustaf Drevin
  • Rachel R Yorlets
  • Emma Svensson
  • Didacus B Namanya
  • Mark G Shrime
  • Peter Kayima

Abstract

Introduction: Half of all Ugandans (49%) turn to the private or private-not-for-profit (PNFP) sectors when faced with illness, yet little is known about the capacity of these sectors to deliver surgical services. We partnered with the Ministry of Health to conduct a nationwide mixed-methods evaluation of private and PNFP surgical capacity in Uganda. Methods: A standardized validated facility assessment tool was utilized to assess facility infrastructure, service delivery, workforce, information management, and financing at a randomized nationally representative sample of 16 private and PNFP hospitals. Semi-structured interviews were conducted to qualitatively explore facilitating factors and barriers to surgical, obstetric and anaesthesia (SOA) care. Hospitals walk-throughs and retrospective reviews of operative logbooks were completed. Results: Hospitals had a median of 177 beds and two operating rooms. Ten hospitals (62.5%) were able to perform all Bellwether procedures (cesarean section, laparotomy and open fracture treatment). Thirty-day surgical volume averaged 102 cases per facility. While most hospitals had electricity, oxygen, running water, and necessary equipment, many reported pervasive shortages of blood, surgical consumables, and anesthetic drugs. Several themes emerged from the qualitative analysis: (1) geographic distance and limited transportation options delay reaching care; (2) workforce shortages impede the delivery of surgical care; (3) emergency and obstetric volume overwhelm the surgical system; (4) medical and non-medical costs delay seeking, reaching, and receiving care; and (5) there is poor coordination of care with insufficient support systems. Conclusion: As in Uganda’s public sector, barriers to surgery in private and PNFP hospitals in Uganda are cross-cutting and closely tied to resource availability. Critical policy and programmatic developments are essential to build and strengthen Ugandan surgical capacity across all sectors.

Suggested Citation

  • Katherine Albutt & Gustaf Drevin & Rachel R Yorlets & Emma Svensson & Didacus B Namanya & Mark G Shrime & Peter Kayima, 2019. "‘We are all serving the same Ugandans’: A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-17, October.
    • Handle: RePEc:plo:pone00:0224215
    DOI: 10.1371/journal.pone.0224215
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224215
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0224215&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0224215?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Adam Wagstaff & Eddy van Doorslaer, 2003. "Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 921-933, November.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Mohammad Abu-Zaineh & Habiba Romdhane & Bruno Ventelou & Jean-Paul Moatti & Arfa Chokri, 2013. "Appraising financial protection in health: the case of Tunisia," International Journal of Health Economics and Management, Springer, vol. 13(1), pages 73-93, March.
    2. Rahman, Md Mizanur & Jung, Jenny & Islam, Md Rashedul & Rahman, Md Mahfuzur & Nakamura, Ryota & Akter, Shamima & Sato, Motohiro, 2022. "Global, regional, and national progress in financial risk protection towards universal health coverage, 2000–2030," Social Science & Medicine, Elsevier, vol. 312(C).
    3. Wagstaff, Adam & Yu, Shengchao, 2007. "Do health sector reforms have their intended impacts?: The World Bank's Health VIII project in Gansu province, China," Journal of Health Economics, Elsevier, vol. 26(3), pages 505-535, May.
    4. Phuong Huu Khiem & Yu-Chen Kuo, 2022. "Health insurance reform impact on children’s educational attainment: evidence from Vietnam," Review of Economics of the Household, Springer, vol. 20(4), pages 1255-1285, December.
    5. Ryoko Sato, 2022. "Catastrophic health expenditure and its determinants among Nigerian households," International Journal of Health Economics and Management, Springer, vol. 22(4), pages 459-470, December.
    6. Neelsen, Sven & Limwattananon, Supon & O'Donnell, Owen & van Doorslaer, Eddy, 2019. "Universal health coverage: A (social insurance) job half done?," World Development, Elsevier, vol. 113(C), pages 246-258.
    7. Tomson Ogwang & Germano Mwabu, 2024. "Adaptation of the Foster‐Greer‐Thorbecke poverty measures for the measurement of catastrophic health expenditures," Health Economics, John Wiley & Sons, Ltd., vol. 33(10), pages 2419-2436, October.
    8. repec:eid:wpaper:3/09 is not listed on IDEAS
    9. Javkhlanbayar Dorjdagva & Enkhjargal Batbaatar & Mikael Svensson & Bayarsaikhan Dorjsuren & Munkhsaikhan Togtmol & Jussi Kauhanen, 2021. "Does social health insurance prevent financial hardship in Mongolia? Inpatient care: A case in point," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-12, March.
    10. Rama Pal, 2012. "Measuring incidence of catastrophic out-of-pocket health expenditure: with application to India," International Journal of Health Economics and Management, Springer, vol. 12(1), pages 63-85, March.
    11. Łuczak, Julita & García-Gómez, Pilar, 2012. "Financial burden of drug expenditures in Poland," Health Policy, Elsevier, vol. 105(2), pages 256-264.
    12. Bonu, Sekhar & Bhushan, Indu & Peters, David, 2007. "Incidence, Intensity, and Correlates of Catastrophic Out-of-Pocket Health Payments in India," ADB Economics Working Paper Series 102, Asian Development Bank.
    13. Indrani Gupta, 2015. "Financing for Health Coverage in India: Issues and Concerns," Working Papers id:7008, eSocialSciences.
    14. Richard Mussa, 2016. "Exit from catastrophic health payments: a method and an application to Malawi," International Journal of Health Economics and Management, Springer, vol. 16(2), pages 163-174, June.
    15. Bernal, Noelia & Carpio, Miguel A. & Klein, Tobias J., 2017. "The effects of access to health insurance: Evidence from a regression discontinuity design in Peru," Journal of Public Economics, Elsevier, vol. 154(C), pages 122-136.
    16. Md. Mizanur Rahman & Md. Rashedul Islam & Md. Shafiur Rahman & Fahima Hossain & Ashraful Alam & Md. Obaidur Rahman & Jenny Jung & Shamima Akter, 2022. "Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis," Health Economics Review, Springer, vol. 12(1), pages 1-11, December.
    17. Rama Pal, 2010. "Analysing Catastrophic OOP Health Expenditure in India: Concepts, Determinants and Policy Implications," Working Papers id:2420, eSocialSciences.
    18. Ajay Kumar & H. R. Sharma & Sanal Gupta, 2023. "Extent and determinants of catastrophic health expenditure in rural areas of Himachal Pradesh, India," Asia-Pacific Journal of Regional Science, Springer, vol. 7(4), pages 1289-1305, December.
    19. Dilek Basar & Sarah Brown & Arne Risa Hole, 2012. "Out-of-Pocket Health Care Expenditure in Turkey: Analysis of the Household Budget Surveys 2002-2008," Working Papers 2012020, The University of Sheffield, Department of Economics.
    20. Jay Dev Dubey, 2021. "Measuring Income Elasticity of Healthcare-Seeking Behavior in India: A Conditional Quantile Regression Approach," Journal of Quantitative Economics, Springer;The Indian Econometric Society (TIES), vol. 19(4), pages 767-793, December.
    21. Chaudhuri, Anoshua & Roy, Kakoli, 2008. "Changes in out-of-pocket payments for healthcare in Vietnam and its impact on equity in payments, 1992-2002," Health Policy, Elsevier, vol. 88(1), pages 38-48, October.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0224215. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.