A qualitative study of the perspectives of health workers and policy makers on external support provided to low-level private health facilities in a Ugandan rural district, in management of childhood infections

Figures & data

Figure 1. Map of Uganda showing location of Mbarara District. Extended is the map of Mbarara district, showing the sub counties where the study was carried out

Table 1. The health facility classification in Uganda

Level of Health Unit	Target population	Services provided and structures
Village Health Teams (Health Centre I)	1,000.	First contact for populations living in rural areas providing community-based preventive and health- promotion services, community mobilisation and referral of sick members to health facilities. No physical structures
Health Centre II	5,000	Parish-level facility offering Disease Prevention, Health Promotion and Outpatient Curative Health Services for uncomplicated conditions, antenatal care and immunisation for children.
Health Centre III	20,000	Sub county-level facility offering Preventive, Health Promotion, Outpatient Curative, Maternity, inpatient Health Services and Laboratory services for malaria testing and tuberculosis microscopy
Health Centre IV	100,000	County-level facility offering disease Preventive services, Health Promotion, Outpatient Curative, Maternity, inpatient Health Services, Emergency surgery and Blood transfusion and Laboratory services
General Hospital	500,000	District-level facility. In addition to services offered at HC IV, offers general services and in-service training, consultation and research to community based health care programs.
Regional Referral Hospital	2,000,000	In addition to services offered at the general hospital, offers specialist services, such as psychiatry, Ear, Nose and Throat, Ophthalmology, dentistry, intensive care, radiology, pathology, higher-level surgical and medical services.
National Referral Hospital	10,000,000	Offers comprehensive specialist services and are involved in teaching and research.

Source: Ministry of Health Annual Health Sector Performance report 2018–2019.

Table 2. Characteristics of the study participants

Characteristic	Private health care workers N = 30, n (%)	Policy makers N = 13, n (%)
Gender
Female	12(40)	6 (46)
Male	18 (60)	7 (54)
Duration in service
6 months to 1 year	4 (13)	0 (0)
>1 to 5 years	12(40)	3 (23)
>5 years	14 (47)	10 (77)
Profession
Nursing assistant	3(10)	0(0)
Nurse/Midwife	17(57)	5(39)
Clinical Officer	6 (20)	3(23)
Medical doctor	3(10)	2(15)
Other*	1(3)	3(23)

*Other – 1 laboratory assistant, 1 health educator, 2 health inspectors.

Table 3. Summary of the themes and their categories and sub-categories

Sub-categories	Categories	Themes
Make medical care affordable Mitigate providers’ knowledge gaps	Improve access and quality of health care provided by LLPHF	Importance of external support to LLPHF
Guidelines Vaccines Inspection	Types of support received by the LLPHF	Nature of current support received by LLPHF
Guidelines are rare in lower private facilities, Supervision is more fault finding than supportive	Appraisal of the current support received by LLPHF
Training Support supervision	Technical capacity building	Support preferred by the LLPHF
Guidelines Supplies Subsidies	Tools and supplies
Registration of LLPHF Regular submission of reports Join existing bureaus Commitment by LLPHF	Self-initiative of the LLPHF to comply with regulations	Suggestions to improve support to LLPHF
Ministry of health District NGOs Clinic owners	Multi-stakeholder involvement

Table

Facility levelMandatory registration of private clinics with regulatory bodies Submission of performance reports to the MoH and DHO regularly Joining already existing organisations such as medical bureaus to access support District health office levelAdapting a more supportive form of supervision with the involvement of stakeholders Regulate the quantity of private clinics in the district to manageable numbers Identify and encourage formation of LLPHF coalitions through which support can be delivered Ministry of health and national and international development partnersIdentify and encourage formation of LLPHF coalitions through which support can be delivered. Identifying and put in place innovative training and mentoring strategies Ensure availability of guidelines and that national and international policies reach these calibers of healthcare providers