There is a growing concern that the traditional-budget-based financing of health services does no... more There is a growing concern that the traditional-budget-based financing of health services does not have adequate incentive to stimulate health sector performance improvement in terms of outputs and quality. Despite increased development aid towards health over the years, most of the low-income countries remain far from attaining the health-related Millennium Development Goals (MDGs). Performance based financing (PBF) has slowly gained favor as one of the provider payment mechanism that can partly address current performance challenges in the health sector. Cordaid piloted PBF in level IIIs primary health care facilities of Jinja diocese for 3 years (from 2009/10 to 2011/12). We conducted this study to assess the effects of PBF on the performance of the HCIIIs. The descriptive, cross-sectional study with a comparative component was carried out in 4 HC IIIs of Jinja diocese from 12th June to 22nd July 2012. We collected and analyzed annual performance data from health facility records on selected outputs for the 2 years before and after roll-out of PBF – comparing the study health facilities with an equal number of controls of the same level. We also analyzed data on selected quality indicators. After start of PBF, there was a positive trend in performance of the PBF- implementing health facilities relative to the controls. Human resource as a proxy marker of quality of inputs stood lower in the study health facilities than controls. We concluded that there was a positive trend in performance in the selected indicators in the PBF H/Cs. To create credibility to the observed performance, there is need to have a rigorous, regular and independent data verification plan built within the implementation process. We recommend piloting of this PBF approach in more health facilities and of bigger coverage like level IV health facilities and hospitals so as to gain more insight on what effect it can have on Uganda’s health system and related contexts.
Active and systematic engagement of key stakeholders at all levels, from policy-formulation to he... more Active and systematic engagement of key stakeholders at all levels, from policy-formulation to health service delivery is crucial for success of any health system. In this study, we assessed the perspectives of Lower Local Government (LLG) stakeholders on utilization of Maternal and Child Health (MCH) services; and their roles in North Western Uganda. We conducted a qualitative study in four LLGs in North Western Uganda. In-depth interviews were carried out with elected LLG leaders, health center III in-charges, and midwives. Focus Group Discussions (FGDs) were held with Traditional Birth Attendants (TBAs). Combined analysis of in-depth interviews (IIs) and FGDs followed predetermined themes that include; stakeholder views on utilization of antenatal care, facility delivery, postnatal care, and childhood immunization services and their rolesin improving each of these services. All the stakeholders reported relatively high utilization rates for antenatal care and childhood immunization. They reported a low-level of uptake of health facility delivery and postnatal care services. They all saw themselves as key to effective domestication of internationally and nationally originated health care initiatives. The stakeholders identified the following as barriers to maternal and child health services’ utilization; low capacity of local governments in localizing national polices and strategies as well as formulating local ones, inadequate interaction between the local stakeholders, inadequate resources, misconceptions, and continued belief in home-based service providers. The study showed that LLG stakeholders are aware of the status of utilization of MCH services, the challenges and their roles. Deliberate, systematic and active engagement of LLG stakeholders at all stages of implementation of MCH services is critical; more so in a decentralized dispensation. This effectively fastens domestication and decentralization of global health initiatives.
There is a growing concern that the traditional-budget-based financing of health services does no... more There is a growing concern that the traditional-budget-based financing of health services does not have adequate incentive to stimulate health sector performance improvement in terms of outputs and quality. Despite increased development aid towards health over the years, most of the low-income countries remain far from attaining the health-related Millennium Development Goals (MDGs). Performance based financing (PBF) has slowly gained favor as one of the provider payment mechanism that can partly address current performance challenges in the health sector. Cordaid piloted PBF in level IIIs primary health care facilities of Jinja diocese for 3 years (from 2009/10 to 2011/12). We conducted this study to assess the effects of PBF on the performance of the HCIIIs. The descriptive, cross-sectional study with a comparative component was carried out in 4 HC IIIs of Jinja diocese from 12th June to 22nd July 2012. We collected and analyzed annual performance data from health facility records on selected outputs for the 2 years before and after roll-out of PBF – comparing the study health facilities with an equal number of controls of the same level. We also analyzed data on selected quality indicators. After start of PBF, there was a positive trend in performance of the PBF- implementing health facilities relative to the controls. Human resource as a proxy marker of quality of inputs stood lower in the study health facilities than controls. We concluded that there was a positive trend in performance in the selected indicators in the PBF H/Cs. To create credibility to the observed performance, there is need to have a rigorous, regular and independent data verification plan built within the implementation process. We recommend piloting of this PBF approach in more health facilities and of bigger coverage like level IV health facilities and hospitals so as to gain more insight on what effect it can have on Uganda’s health system and related contexts.
Active and systematic engagement of key stakeholders at all levels, from policy-formulation to he... more Active and systematic engagement of key stakeholders at all levels, from policy-formulation to health service delivery is crucial for success of any health system. In this study, we assessed the perspectives of Lower Local Government (LLG) stakeholders on utilization of Maternal and Child Health (MCH) services; and their roles in North Western Uganda. We conducted a qualitative study in four LLGs in North Western Uganda. In-depth interviews were carried out with elected LLG leaders, health center III in-charges, and midwives. Focus Group Discussions (FGDs) were held with Traditional Birth Attendants (TBAs). Combined analysis of in-depth interviews (IIs) and FGDs followed predetermined themes that include; stakeholder views on utilization of antenatal care, facility delivery, postnatal care, and childhood immunization services and their rolesin improving each of these services. All the stakeholders reported relatively high utilization rates for antenatal care and childhood immunization. They reported a low-level of uptake of health facility delivery and postnatal care services. They all saw themselves as key to effective domestication of internationally and nationally originated health care initiatives. The stakeholders identified the following as barriers to maternal and child health services’ utilization; low capacity of local governments in localizing national polices and strategies as well as formulating local ones, inadequate interaction between the local stakeholders, inadequate resources, misconceptions, and continued belief in home-based service providers. The study showed that LLG stakeholders are aware of the status of utilization of MCH services, the challenges and their roles. Deliberate, systematic and active engagement of LLG stakeholders at all stages of implementation of MCH services is critical; more so in a decentralized dispensation. This effectively fastens domestication and decentralization of global health initiatives.
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Papers by Rogers Ayiko
it can have on Uganda’s health system and related contexts.
services. All the stakeholders reported relatively high utilization rates for antenatal care and childhood immunization. They
reported a low-level of uptake of health facility delivery and postnatal care services. They all saw themselves as key to effective domestication of internationally and nationally originated health care initiatives. The stakeholders identified the following as barriers to maternal and child health services’ utilization; low capacity of local governments in localizing national polices and strategies as well as formulating local ones, inadequate interaction between the local stakeholders, inadequate resources, misconceptions, and continued belief in home-based service providers. The study showed that LLG stakeholders are aware of the status of utilization of MCH services, the challenges and their roles. Deliberate, systematic and active engagement of LLG stakeholders at all stages of implementation of MCH services is critical; more so in a decentralized dispensation. This
effectively fastens domestication and decentralization of global health initiatives.
it can have on Uganda’s health system and related contexts.
services. All the stakeholders reported relatively high utilization rates for antenatal care and childhood immunization. They
reported a low-level of uptake of health facility delivery and postnatal care services. They all saw themselves as key to effective domestication of internationally and nationally originated health care initiatives. The stakeholders identified the following as barriers to maternal and child health services’ utilization; low capacity of local governments in localizing national polices and strategies as well as formulating local ones, inadequate interaction between the local stakeholders, inadequate resources, misconceptions, and continued belief in home-based service providers. The study showed that LLG stakeholders are aware of the status of utilization of MCH services, the challenges and their roles. Deliberate, systematic and active engagement of LLG stakeholders at all stages of implementation of MCH services is critical; more so in a decentralized dispensation. This
effectively fastens domestication and decentralization of global health initiatives.