Injection Use and Practices in Uganda - EDM Research Series No. 014
(1994; 54 pages) Ver el documento en el formato PDF
Índice de contenido
Ver el documentoACKNOWLEDGEMENTS
Cerrar esta carpeta1. INTRODUCTION
Ver el documento1.1 Problem statement
Ver el documento1.2 Objectives of the study
Cerrar esta carpeta1.3 Background to the country situation
Ver el documento1.3.1 Health care in Uganda and injection use
Ver el documento1.3.2 Sources of equipment and injectables
Abrir esta carpeta y ver su contenido2. METHODOLOGY
Abrir esta carpeta y ver su contenido3. EXTENT OF INJECTION USE
Abrir esta carpeta y ver su contenido4. HYGIENE OF INJECTION PRACTICE
Ver el documento5. POPULARITY OF INJECTIONS
Abrir esta carpeta y ver su contenido6. CONCLUSIONS AND RECOMMENDATIONS
Ver el documentoREFERENCES
Abrir esta carpeta y ver su contenidoLIST OF APPENDICES
Ver el documentoOTHER DOCUMENTS IN THE DAP RESEARCH SERIES
 

1.3.1 Health care in Uganda and injection use

In the 1960s, Uganda had one of the best health care systems in Africa. It had a comprehensive institutional referral system, from numerous rural dispensaries, through to health centres, maternity units, district and regional hospitals to a National referral hospital (Dodge and Wiebe 1989). These units were run by trained health workers, with medical doctors stationed at hospitals, while medical assistants and nurses managed the rural health units. Additionally, private medical services provided by missionaries and an insignificant number of private clinics run by licensed medical practitioners complemented government services. Medical services were free at government units and those provided in private units were relatively cheap. The Pharmacy and Drug Act of 1970 restricts the provision of injections to these officially recognized health services. It states: “...no person shall have in his possession, without lawful excuse, the proof wherein shall lie on him, any syringe designed for injection” (Pharmacy and Drug Act 1970: 1116).

During the 1970s and 1980s, a precipitous decline in the country’s economy led to a decrease in government expenditure on health care delivery (see Table 1) and to a breakdown in the health care system. Medicine supplies became irregular and many health professionals left the country.3 Immunization programmes broke down; only the mission health facilities continued functioning reasonably.

3 The ratio of physicians to population halved in the past 25 years from 1:11,000 in 1965 to 1:28,000 in 1991 (UEDMP 1992).

Table 1: Ministry of Health recurrent expenditure, 1971-1991 in millions of Ugandan Shillings (Source: Ministry of Health: Health Planning Unit 1992)

Period

70/71

82/83

84/85

86/87

88/89

90/91

Money expenditure

1

21

66

180

2,629

3,514

Real expenditure (adjusted to inflation rates)

100

17.6

22.0

7.3

16.9

14.7

The scanty and nearly non-functional health care system gave rise to a number of new local solutions. There was a proliferation of private profit oriented health care providers, such as unlicensed private clinics, drug shops and home providers (Health Review Commission 1987; Whyte 1991). Injection technology also diffused from the established health care system to the informal system. Recently, this process has been accentuated by messages on AIDS education which have undermined confidence in injections from government facilities (Birungi and Whyte 1993; Birungi 1994). Presently, Uganda’s health care system can best be described as having two sectors, the formal and informal, which are closely articulated, exhibiting symbiotic relationships in terms of drug supplies, equipment and human resources (Whyte 1991).

It is estimated that 72% of the country’s population lives over 6 km from a government health centre (UNICEF 1989). Thus there is still a very large proportion of the population which exceeds the WHO recommended accessibility level of within five kilometres. In a household survey undertaken by the Child Health Development Centre in 1990, based on a representative sample of nine districts of Uganda, it is indicated that the government only provides 21% of all out-patient modem curative services, while the private sector accounts for 66% (NGO facilities, private clinics and others). There also exist regional disparities in the location of health facilities, with over 50% of the hospitals situated in urban areas, while the majority of health centres are situated near trading centres leaving rural areas with limited access. Meanwhile, the private clinics which have sprung up all over the country in the recent past have not substantially solved this problem. Since their location is determined by the law of supply and demand, they are strategically located in towns and rural trading centres. Health care personnel are also maldistributed geographically. The urban population which only constitutes 11% of the Ugandan population receives services by 76% of the medical doctors, 64% of the medical assistants, and 72% of the nurses (UEDMP 1992). Apart from the deficit in coverage, the content of health care is largely curative, and almost all forms of treatment involve the use of medicines (World Bank 1992).

Country morbidity and mortality figures for 1991, based on out-patient and in-patient records of 20 government and NGO hospitals, indicate that malaria is the number one cause of death, with AIDS coming second, followed by diarrhoea, pneumonia, and anemia (World Bank 1992). Children under five account for 54% of all hospital deaths with malaria, pneumonia, diarrhoea, and malnutrition causing 55% of the under-five mortality. AIDS is the primary cause of mortality among adults, accounting for 17% of all hospital deaths, followed by tuberculosis, malaria, meningitis, and diarrhoea.

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