Aspirations for quality health care in Uganda: How do we get there?
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RESEARCH
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Aspirations for quality health care in Uganda: How do we get there? Clare I R Chandler1*, James Kizito2, Lilian Taaka2, Christine Nabirye2, Miriam Kayendeke2, Deborah DiLiberto3 and Sarah G Staedke3
Abstract Background: Despite significant investments and reforms, health care remains poor for many in Africa. To design an intervention to improve access and quality of health care at health facilities in eastern Uganda, we aimed to understand local priorities for qualities in health care, and factors that enable or prevent these qualities from being enacted. Methods: In 2009 to 2010, we carried out 69 in-depth interviews and 6 focus group discussions with 65 health workers at 17 health facilities, and 10 focus group discussions with 113 community members in Tororo District, Uganda. Results: Health-care workers and seekers valued technical, interpersonal and resource qualities in their aspirations for health care. However, such qualities were frequently not enacted, and our analysis suggests that meeting aspirations required social and financial resources to negotiate various power structures. Conclusions: We argue that achieving aspirations for qualities valued in health care will require a genuine reorientation of focus by health workers and their managers toward patients, through renewed respect and support for these providers as professionals. Keywords: Africa, Access to health care, Power/empowerment, Quality of care, Relationships, Health care
Background In spite of significant global investment, the majority of developing countries are not on target to achieve Millennium Development Goals 4 and 5, to reduce the under-5 mortality rate by two-thirds and the maternal mortality ratio by three-quarters between 1990 and 2015 [1]. Failure to reach these targets has been blamed on ‘health system bottlenecks’ that prevent the ability to scale up coverage of key interventions [1,2]. Inadequate ‘building blocks of health systems,’ namely the numbers and distribution of health workers, equipment, supplies and infrastructure, are cited as contributing to low coverage of health interventions, with median rates of correct treatment of childhood diarrhoea, pneumonia and malaria below 50% [3]. Accelerated efforts to meet the 2015 targets focus on ‘evidence based interventions’ to be supported by ‘strengthened health systems’ (ibid.). However, many argue that the way services and programs are enacted in practice is a social as well as a * Correspondence: [email protected] 1 Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK Full list of author information is available at the end of the article
structural issue: a function of interactions between clients, communities, health workers and systems [4,5]. Meeting a population’s expectations from provider services has been recognised as central to health system performance [6]. The importance of meeting health worker needs in order to deliver good quality, patient-orient
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