Application of policy guidelines for resource allocation and provision of quality maternal care in public health facilities in Kyenjonjo district Uganda

Abstract

Background: Resource allocation is one of the most controversial issues in the health sector. The government of Uganda introduced policies to facilitate effective resource allocation targeting especially the most vulnerable groups. The fifth Millennium Development Goal strives towards improving maternal health services in particular, and resource allocation to this area is therefore of high importance. This study aimed at assessing the application of policy guidelines for resources allocation and factors affecting provision of quality of care in public health facilities, focusing on maternal health services in Kyenjojo district, Uganda. Materials and methods: This study was conducted in former Kyenjojo district that recently has been divided into Kyenjojo and Kyegegwa districts in western Uganda. It comprised of an in-depth interview of 7 District Health Management Team members, 6 Health Centre three managers, 12 midwives and a cross- sectional survey of 161 mothers of infants. Interview guides were developed for the managers and midwives, and a semi-structured questionnaire was used for the mothers. The study also incorporated 'financial reports' for the financial year 2008/2009. Qualitative data collected was basically on resource allocation process, use of the formula, policy guidelines, allocation to different health activities, timeliness of release of funds and factors affecting provision of quality maternal care. While quantitative data was about utilization of maternal health services. Interviews were upon obtaining signed consent. This study used a mixed method approach. Qualitative and quantitative data were analysed separately, and triangulated in the interpretation phase, for example constraints faced were reported from both methods. The analysis of qualitative and quantitative data used ATLAS.ti 6.1 and SPSS 13.0 respectively. Results: The main findings of this study were: the criterion of resource allocation for health used a level of health facility and a ratio of 1 :2:4 that means HCllls receive funds which are as twice as that of HCII and HCIV is four times as that of HCII. Maternal services were found not to be given a priority by Kyenjojo district health officials due to perceived presence of development partners in the district who were

Vll thought to provide necessary support for that service. The district health financial report for 2008/2009 revealed allowances and transport took 82.0% and less than 1.0% of the annual expenditure was allocated to repair and upkeep of equipment and buildings. Most policy guidelines were not followed as required. The quality of maternal health services was particularly from midwives and found to be substandard due to inadequate human resources and lack of equipment, medicines, accommodation and supplies, delay in funding, poor referral system and lighting system. The interviews with the mothers supported to a large extent dissatisfaction with the maternity services, reporting absence ofthe midwife as one of the most negative experiences. Conclusion: This study highlights the need for improving quality maternal care. If the fifth Millennium Development Goal by 2015 is to be achieved, maternal health services in Uganda need to be improved on the health agenda especially when allocating resources. Recommendations: The district health authority needs to improve and utilize resource allocation guidelines for health, including monitoring quality as a major intermediate objective in all policies. There is also need for research on more equitable and efficiency improving formulae which would facilitate a better provision of quality maternal care.

Background: Resource allocation is one of the most controversial issues in the health sector. The government of Uganda introduced policies to facilitate effective resource allocation targeting especially the most vulnerable groups. The fifth Millennium Development Goal strives towards improving maternal health services in particular, and resource allocation to this area is therefore of high importance. This study aimed at assessing the application of policy guidelines for resources allocation and factors affecting provision of quality of care in public health facilities, focusing on maternal health services in Kyenjojo district, Uganda. Materials and methods: This study was conducted in former Kyenjojo district that recently has been divided into Kyenjojo and Kyegegwa districts in western Uganda. It comprised of an in-depth interview of 7 District Health Management Team members, 6 Health Centre three managers, 12 midwives and a cross- sectional survey of 161 mothers of infants. Interview guides were developed for the managers and midwives, and a semi-structured questionnaire was used for the mothers. The study also incorporated 'financial reports' for the financial year 2008/2009. Qualitative data collected was basically on resource allocation process, use of the formula, policy guidelines, allocation to different health activities, timeliness of release of funds and factors affecting provision of quality maternal care. While quantitative data was about utilization of maternal health services. Interviews were upon obtaining signed consent. This study used a mixed method approach. Qualitative and quantitative data were analysed separately, and triangulated in the interpretation phase, for example constraints faced were reported from both methods. The analysis of qualitative and quantitative data used ATLAS.ti 6.1 and SPSS 13.0 respectively. Results: The main findings of this study were: the criterion of resource allocation for health used a level of health facility and a ratio of 1 :2:4 that means HCllls receive funds which are as twice as that of HCII and HCIV is four times as that of HCII. Maternal services were found not to be given a priority by Kyenjojo district health officials due to perceived presence of development partners in the district who were

Vll thought to provide necessary support for that service. The district health financial report for 2008/2009 revealed allowances and transport took 82.0% and less than 1.0% of the annual expenditure was allocated to repair and upkeep of equipment and buildings. Most policy guidelines were not followed as required. The quality of maternal health services was particularly from midwives and found to be substandard due to inadequate human resources and lack of equipment, medicines, accommodation and supplies, delay in funding, poor referral system and lighting system. The interviews with the mothers supported to a large extent dissatisfaction with the maternity services, reporting absence ofthe midwife as one of the most negative experiences. Conclusion: This study highlights the need for improving quality maternal care. If the fifth Millennium Development Goal by 2015 is to be achieved, maternal health services in Uganda need to be improved on the health agenda especially when allocating resources. Recommendations: The district health authority needs to improve and utilize resource allocation guidelines for health, including monitoring quality as a major intermediate objective in all policies. There is also need for research on more equitable and efficiency improving formulae which would facilitate a better provision of quality maternal care.