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J Prev Med Public Health ; 57(1): 91-94, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38228135


For nearly four decades, Ugandans have experienced a period marked by hope, conflict, and resilience across various aspects of healthcare reform. The health insurance system in Uganda lacks a legal framework and does not extend benefits to the entire population. In Uganda, community-based health insurance is common among those in the informal sector, while private medical insurance is typically provided to employees by their workplaces and agencies. The National Health Insurance Scheme Bill, introduced in 2019, was passed in 2021. If the President of Uganda gives his assent to the National Health Insurance Bill, it will become a significant policy driving health and universal health coverage. However, this bill is not without its shortcomings. In this perspective, we aim to explore the complex interplay of challenges and opportunities facing Uganda's health sector.

Reforma de la Atención de Salud , Seguro de Salud , Programas Nacionales de Salud , Uganda , Cobertura Universal del Seguro de Salud
BMC Health Serv Res ; 23(1): 815, 2023 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-37525192


BACKGROUND: We performed an economic analysis of a new technology used in antenatal care (ANC) clinics, the ANC panel. Introduced in 2019-2020 in five Rwandan districts, the ANC panel screens for four infections [hepatitis B virus (HBV), human immunodeficiency virus (HIV), malaria, and syphilis] using blood from a single fingerstick. It increases the scope and sensitivity of screening over conventional testing. METHODS: We developed and applied an Excel-based economic and epidemiologic model to perform cost-effectiveness and cost-benefit analyses of this technology in Kenya, Rwanda, and Uganda. Costs include the ANC panel itself, its administration, and follow-up treatment. Effectiveness models predicted impacts on maternal and infant mortality and other outcomes. Key parameters are the baseline prevalence of each infection and the effectiveness of early treatment using observations from the Rwanda pilot, national and international literature, and expert opinion. For each parameter, we found the best estimate (with 95% confidence bound). RESULTS: The ANC panel averted 92 (69-115) disability-adjusted life years (DALYs) per 1,000 pregnant women in ANC in Kenya, 54 (52-57) in Rwanda, and 258 (156-360) in Uganda. Net healthcare costs per woman ranged from $0.53 ($0.02-$4.21) in Kenya, $1.77 ($1.23-$5.60) in Rwanda, and negative $5.01 (-$6.45 to $0.48) in Uganda. Incremental cost-effectiveness ratios (ICERs) in dollars per DALY averted were $5.76 (-$3.50-$11.13) in Kenya, $32.62 ($17.54-$46.70) in Rwanda, and negative $19.40 (-$24.18 to -$15.42) in Uganda. Benefit-cost ratios were $17.48 ($15.90-$23.71) in Kenya, $6.20 ($5.91-$6.45) in Rwanda, and $25.36 ($16.88-$33.14) in Uganda. All results appear very favorable and cost-saving in Uganda. CONCLUSION: Though subject to uncertainty, even our lowest estimates were still favorable. By combining field data and literature, the ANC model could be applied to other countries.

Costos de la Atención en Salud , Atención Prenatal , Lactante , Femenino , Embarazo , Humanos , Rwanda/epidemiología , Kenia/epidemiología , Uganda/epidemiología , Análisis Costo-Beneficio
Tob Prev Cessat ; 6: 5, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32548342


INTRODUCTION: Studies in several countries indicate that being a police officer is a risk factor for tobacco use. Currently, no such studies have been performed among police officers in Uganda, or in Africa generally. The aim of this study is to assess prevalence and costs of smoking among Ugandan police officers. METHODS: A multistage survey model was employed to sample police officers (n=349) that included an observational cross-sectional survey and an annual cost-analysis approach. The study setting was confined to Nsambya Police Barracks, in Kampala city. RESULTS: Police officers smoke 4.8 times higher than the general public (25.5% vs 5.3%). Risk factors included lower age, higher education and working in guard and general duties units. The findings show that the annual cost of smoking due to productivity loss could be up to US$5.521 million and US$57.316 million for excess healthcare costs. These costs represent 45.1% of the UGX514.7 billion (in Ugandan Shillings, or about US$139.1 million) national police budget in the fiscal year 2018-19 and is equivalent to 0.24% of Uganda's annual gross domestic product (GDP). CONCLUSIONS: Considering these data, prevalence of smoking among police officers are dramatically higher than in the general population. Consequently, smoking in police officers exerts a large burden on healthcare and productivity costs. This calls for comprehensive tobacco control measures designed to reduce smoking in the workplace so as to fit the specific needs of the Ugandan Police Force.

Tob Control ; 26(3): 330-333, 2017 05.
Artículo en Inglés | MEDLINE | ID: mdl-27165996


BACKGROUND: Although Uganda has a relatively low prevalence of smoking, no data exists on cigarette use among military personnel. Studies in other countries suggests military service is a risk factor for tobacco use. OBJECTIVES: To assess prevalence and risk factors for and costs of smoking among military personnel assigned to a large military facility in Uganda. DESIGN: A mixed methods study including focus groups, interviews and a cross-sectional survey of military personnel. SETTING: Kakiri Barracks, Uganda. SUBJECTS: Key informants and focus group participants were purposively selected based on the objectives of the study, military rank and job categories. A multistage sample design was used to survey individuals serving in Uganda People's Defense Forces (UPDF) from June to November 2014 for the survey (n=310). RESULTS: Participants in the qualitative portion of the study reported that smoking was harmful to health and the national economy and that its use was increasing among UPDF personnel. Survey results suggested that smoking rates in the military were substantially higher than in the general public (ie, 34.8% vs 5.3%). Significant predictors of smoking included lower education, younger age, having close friends who smoked and a history of military deployment. Estimated costs of smoking due to lost productivity was US$576 229 and US$212 400 for excess healthcare costs. CONCLUSIONS: Smoking rates are substantially higher in the UPDF compared to the general public and results in significant productivity costs. Interventions designed to reduce smoking among UPDF personnel should be included in the country's national tobacco control plan.

Costo de Enfermedad , Eficiencia , Personal Militar/estadística & datos numéricos , Fumar/epidemiología , Adolescente , Adulto , Factores de Edad , Estudios Transversales , Escolaridad , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Fumar/economía , Encuestas y Cuestionarios , Uganda/epidemiología , Lugar de Trabajo , Adulto Joven