Posted: 20 Jun 2007
Background: Access to health care in Uganda has been difficult to ascertain because of the wide range in estimates by different stakeholders. The factors that make rural residents choose which health care provider to consult were also not clearly known.
Objectives: To study the health seeking behaviours of persons who experienced an illness within a given period of time and investigate the reasons for their actions so as to make inferences on access to health care.
Methods: Strategies included (1) Census mapping of all health care providers in defined areas; (2) A household survey to quantify the amount of illness in the community during a fixed period of time and to document what people did about their illnesses; (3) A health facility survey to assess the quality of care at the available facilities. The study was coducted in 3 Uganda districts (Mpigi, Iganga, Masaka) in 2005. All those who experienced an illness in the 30 days before the interview were interviewed about what they did and why.
Results: The census mapping showed that private units far out numbered public units. Public facilities made up only 4.4% of all units, but many of the private units were informal, with limited infrastructure and uncertain quality of services. In the household survey 2580 persons were interviewed and 42% (1097) reported that they experienced some illness during the prevous 30 days. Of the 1097 who got some illness, 88% (967/1097) sought for and received some type of health care while 12% (130) did nothing about the illness. Reasons for doing nothing included minor problem, lack of money or lack of transport. Of those who sought for care 71% (687/967) visited a provider while 47% (452/967) self treated, (18% did both). The total number of treatment episodes was therefore 1139 and 40% of them were self treatment. Of those that visited a provider 63% (433/687) went to private providers while 37% (254/687) went to the public sector. Private providers include: private for profit, private not for profit and informal providers. Informal providers comprised of traditional healers and general merchandise shops. These provided care to 11.5% (79/687) of people who sought for care. The main reasons for choice of a provider were convenient location and perceived technical skills (quality) of the provider. Overall, the private for profit facilities, mainly private clinics and drug shops, were the most popular for ambulatory health care, while public facilities were preferred for more serious conditions and for hospitalisation. Although traditional healers are very numerous, they are not the popular choice for the commonest illnesses such as fever and cough. They were more renown for handling social problems including family relations and wealth. While they also treat some illnesses, there is an emerging view that many traditional healers are more of social workers than medical workers.
Conclusions: Most of the persons who experienced an illness sought for health care and the private sector was the most utilised. There is a big pool of informal health care providers in the community, whose skills may be improved to enhance access to and quality of health care in the rural areas of Uganda.
Keywords: access to health care, choice of health care provider, quality of care
Suggested Citation: Suggested Citation
Konde-Lule, Joseph and Gitta, Sheba and Okuonzi, Sam and Matsiko, Charles Wycliffe, Access to Health Care in Rural Uganda. iHEA 2007 6th World Congress: Explorations in Health Economics Paper. Available at SSRN: https://ssrn.com/abstract=992239