Using information and communication technology to revitalise continuing professional development for rural health professionals: evidence from a pilot project.

This project revitalised continuing professional development (CPD) among rural health professionals in Uganda, Africa, using information and communication technology (ICT). The project was piloted in 3 rural hospitals where CPD activities were failing to meet demand because activities were not properly coordinated, the meetings were too infrequent, the delivery methods were inappropriate, and the content was highly supply-driven and generally irrelevant to the performance needs of the health workers. The project intervention involved the installation of various ICT equipment including computers, liquid crystal display (LCD) projectors, office copiers, printers, spiral binders and CDs. A number of health workers were also trained in ICT use. Three years later, an evaluation study was conducted using interviews, focus group discussions and document review. The results indicated that there had been a rapid increase in the number of staff attending the CPD sessions, an increased staff mix among participants, improved quality of CPD presentations, increased use of locally produced content, more relevant topics discussed and an increased interest by hospital management in CPD, manifested by commitment of staff training funds. Staff motivation, attitude and responsiveness to clients had also improved as a result of the invigorated CPD activities.

Strategies for sustainability and equity of prepayment health schemes in Uganda.

BACKGROUND: Despite the long existence of community health insurance schemes (CHI) in Uganda, their numbers and coverage levels have remained small with limited accessibility by the poor. OBJECTIVES: To examine issues of equity and sustainability in CHI schemes, which are prerequisites to health sector financing. METHODS: We carried out a descriptive cross-sectional study employing qualitative techniques. Eight focus group discussions (FGDs) with CHI scheme members and seven FGDs with non-members were held. Twelve Key informant interviews (KIs) were held with scheme managers, officials from Ministry of Health and one health financing organisation. We reviewed relevant documents and records of schemes. RESULTS: Respondents' perceptions of unfairness in schemes were: non-members were treated better in hospital than members; some members pay premiums continuously without falling sick and schemes refused to cover illnesses like diabetes and hypertension. Fairness was related with the very little payment for the services received, members paying less than non-members but both getting the same treatment and no patient discrimination based on gender, age or social status. Schemes are not sustainable because they operate on small budgets, have low enrolment and lack government support. Effect of abolition of user fees on scheme enrolment was minimal. CONCLUSION: Government should ensure that quality of health care does not deteriorate in the context of increased utilisation after user fees removal, schemes need substantial support to build their sustainability and there is need for technical and policy considerations about whether or not CHI has a role to play in Ugandan health system.

The Challenges of Managing Government-Seconded Health Workers in Private not-for-Profit Health Facilities of Kibaale District; Uganda

Private health care providers are an important component of pluralistic national health systems. In Uganda; the public-private partnership for health (PPPH) has led to the government assisting the private health sector in various ways; in recognition of and support to their work. Apart from financial assistance; the government deploys civil servants to work in private-not-for-profit (PNFP) health facilities. Such government-seconded health workers are recruited; deployed and paid by the government but they work under the management of the PNFP health units. In the rural and remote district of Kibaale in mid-western Uganda; government-seconded health workers form 48of the key professional staff in PNFP health services. However; government secondment raises a number of important managerial and human resource challenges. PNFP health care managers have some workers over whom they do not have full authority and control. The seconded workers have to serve two authorities and satisfy them equally. This cross-sectional descriptive study aimed at identifying the problems arising from this kind of relationship in a district where PNFP health units are heavily dependent on government-seconded personnel; and how such problems may be addressed. It was found that there is unequal treatment of seconded and non-seconded staff; with the former receiving better pay; and having more professional management than the latter. However; they felt there was too much workload in PNFP units compared to government and were not comfortable with the PNFP prohibition of private practice. In addition; they felt that they were not trusted by the PNFP managers and that they had limited or no opportunities for career development and further studies. PNFP managers felt they had no control over seconded staff and felt that they have no possibility to participate in the selection of staff to be seconded to their units. As a result; seconded staff were perceived to have no commitment to work in PNFP units; and to be prone to absenteeism; illegal private practice; demand for big financial allowances; abrupt attrition and pilferage of health care supplies. This paper proposes quick enactment of the PPPH policy to define the relationship between the public and the private sectors. It also proposes that the government gives unconditional funding to the PNFP facilities on a contractual basis; and only demands for accountability on agreed outputs. This would facilitate the PNFP managers to recruit their own staff and endeavour to attain the agreed outputs