The DHS Program

September 11, 2008 
Lack of preventative care, poor infection control major challenges in Uganda

Calverton, MD - More than 70 percent of health care facilities in Uganda offer basic health services--curative care for sick children, immunisation, treatment of sexually transmitted infections, and family planning; 45 percent of facilities provide 24-hour services for childbirth. Preventive care and counseling are far less available. Lack of running water and shortages of some types of medicines compromise the quality of care offered to children and adults. These problems are found nationwide, in both governmental and non-governmental facilities, and in all types of facilities, according to a new survey conducted by the Ministry of Health.

The survey, called the 2007 Uganda Service Provision Assessment Survey (USPA), was carried out by the Ministry of Health in collaboration with the Uganda Bureau of Statistics and with funding and support from the United States Government. The USPA collected data from a nationally representative sample of 491health care facilities throughout Uganda, covering all levels of facilities, from HC-IIs to national referral hospitals.

The new study shows that while many critical gaps exist, there are important strengths in Uganda's health care system. More than 70 percent of all health facilities offer a full range of basic health services, including child care, family planning, and treatment for infectious diseases. Curative care for sick children and treatment for malaria and sexually transmitted infections are almost universally available. Most hospitals and HC-IVs offer 24-hour delivery services for pregnant women.

As a result of long-term government efforts, almost all hospitals and HC-IVs provide HIV counseling and testing, care and support for people infected with HIV, and prevention of mother-to-child transmission services (PMTCT). In addition, 84 percent of hospitals and 52 percent of HC-IVs provide antiretroviral treatment. However, most of these facilities had stock outs of first-line antiretroviral medication in the six months preceding the survey, which endangers patients and increases the risk of widespread drug resistance.

Problems with infrastructure and infection control plague Ugandan health care services. Only 31 percent of health care facilities in Uganda, including 64 percent of all hospitals, have a regular water supply, and even fewer, 24 percent, have regular electricity or a generator. Other items needed for infection control are also in short supply; more than half of facilities do not have soap or disinfectant, and 42 percent do not have latex gloves. "These conditions put both providers and clients at risk," said Dr. Sam Zaramba, Director General of Health Services, who officially opened the seminar disseminating USPA results. "It is our job to improve infection control in every health care facility in Uganda."

The absence of routine preventive care and counseling is another source of concern. For example, while 88 percent of all facilities offer immunisation, most provide this service only one or two days per week, and one-fourth of facilities do not have all the basic vaccines in stock. In addition, providers are not routinely promoting immunisation during sick child visits as recommended by Government of Uganda guidelines. These findings are particularly disturbing since less than half of Ugandan children age 12 to 23 months are fully immunised. Ugandan children are much less likely to be fully immunised (46 percent) than children in neighboring Kenya (57 percent), Rwanda (75 percent), and Tanzania (71 percent). In addition, providers are also not routinely giving insecticide-treated mosquito nets to pregnant women during antenatal care visits although the risk of contracting malaria increases during pregnancy. "Preventive care is just as critical as treatment," said Dr. Nathan Kenya-Mugisha, Director of Health Services. "We need to provide patients and caregivers with the information and tools they need to protect them and their children."

Funding for the survey and for technical assistance by Macro International through the MEASURE DHS project was provided by the United States Agency for International Development (USAID), the President's Emergency Plan for AIDS Relief (PEPFAR), and the President's Malaria Initiative (PMI).

For media inquiries in Uganda, please contact: Paul Kagwa, Assistant Commissioner Health Services, Health Promotion and Education; Telephone: 414-344-775.