Making Health Systems Work for the Poor

Disparities in Access to Quality Care

Ekirapa-Kiracho E, Kiwanuka SN, Bishai D, Olico O, Pariyo.G

Outline

Introduction Specific Objectives Methods Results Conclusions

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Introduction

• Access to quality health care still a challenge

• In Uganda - physical access has improved 49% in 1999 to 72% in 2005

[(UBoS 2002; GoU 2005)] 3

Introduction

• Physical access alone is not enough

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Specific Objectives

• To assess the quality of out patient care provided to patients by PNFP and Public providers

• To assess the quality of out patient care provided to patients of different socioeconomic status

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Methods

Design: Analytic cross-sectional study

Setting: 10 public and 10 private not for profit health facilities in Eastern and Western Uganda

Sample size : 1446 patients

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Data collection methods

•Observations of patient provider interactions in the outpatients’ clinics

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Data collection methods

• Exit interviews

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Data collection methods

Structural components -Checklist

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Analytical methods

PCA and raw scores to construct the indices used to assess

different components of quality

socioeconomic status

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Analytical methods

Regression analysis to compare different components of quality of care and

Ownership of the facilities

Socioeconomic status of patients

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Analytic framework - Donabedian

Inputs – drugs, supplies, health workers

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Analytic framework

• Process - provider - patient interactions

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Measures used to asses Quality

General performance Communication quality Availability of essential drugs Availability of essential

supplies

• Variables used in the measurements were determined using PCA

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General health worker performance

Asked about immunization card Checked blood pressure in adults Told patient name of the disease Explained the disease, causes and

course Explained precautions and nursing

care to take

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Variables used to measure communication quality

Told patient name of the disease Explained the disease, causes and

cousre Explained precautions and nursing Told patient name of medicine Explained how to take medicine

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Variables used to assess essential drugs

Amoxil Procaine Penicillin Ferrous sulphate

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Variables used to assess availability of essential Supplies

5% dextrose Water for injection Normal saline Giving sets Cannulas and butter flies

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Variables used in the asset index

Type of material used for the roof, floor and wall of the house

Type of fuel used for cooking Type of fuel used for lighting Type of latrine used Source of water for cooking and

drinking Ownership of assets eg Bicycle

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Results

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Availability of essential supplies

• The Public facilities were better stocked with essential supplies than the PNFP facilities

( Co-eff –1.82) (C.I -.377 -3.24)

• Patients of different socioeconomic status used facilities that had similar levels of essential supplies (Co-eff 0.020) ( C.I -0.18 0.22 )

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Availability of essential drugs

• The Public facilities were better stocked with essential drugs than the PNFP facilities

(Co-eff -1.58)

(C.I -0.29, – 2.87 )

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Availability of essential drugs

• Patients of different socioeconomic status used facilities that had similar levels of essential drugs

(Co-eff -0.30)

( C.I 0.18, -.24 )

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Quality of general health worker performance

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General health worker performance

• Regression analysis-No significant difference in the general performance of health workers

Patients of different socioeconomic status

( Co-eff = 0.006) (C.I -0.68,0.08)

In Public & PNFP owned facilities ( Co-eff= 0.62) (C.I -0.15,1.40)

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Quality of communication

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Quality of communication quality

• No statistical difference in the communication quality of care provided by the public and PNFP providers

(Co-eff 0.34)

(C.I -0.56,1.25)

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Quality of communication

• No statistical difference in the communication quality of care provided to patients of different socioeconomic status

(Co-eff 0.037) (C.I -0.05,0.12)

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Use of PNFP and Public facilities

• Patients of different social economic status used PNFP and Public facilities for out patient care almost equally

( Coeff 0.21) ( C.I - 0.31, 0.75)

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Limitations

• Only outpatient care was assessed• Study was done in only 10 public

and 10 PNFP facilities – Type 1 error possible

• Use of asset index to asses socioeconomic status

• Presented results for only some aspects of quality of care

• More rural facilities than urban

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Conclusions

?

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Conclusions

Public facilities were better stocked with essential supplies and drugs than the PNFP facilities

The general performance of health workers and the quality of their communication with patients was poor

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Conclusions

No major disparities seen in the general performance of health workers when providing care to outpatients of different socioeconomic status in a setting with minimal differences in socioeconomic status

No major disparities seen in the quality of communication care provided to outpatients of different socioeconomic status in a setting with minimal differences in socioeconomic status

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Recommendations

Evaluate the adequacy of subsidies provided by the government to PNFP facilities

Regular assessments aimed at improving the quality of services provided at PNFP and public facilities should be undertaken

Further assessments of quality of care provided to patients of different socioeconomic status in different settings in Uganda

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Acknowledgements

•DFID•Researchers and district officials

•Partner institutions from the FHS RPC

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Thank you for listening or ………

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