Comparison of the capacity between public and private health facilities to manage under-five children with febrile illnesses in Uganda

Elizeus Rutebemberwa,Pascal Magnussen,Sham Lal,Sîan E. Clarke,Esther Buregyeya,Kristian S. Hansen,Anthony K. Mbonye,Phillip LaRussa

doi:10.1186/s12936-017-1842-8

Abstract

BackgroundPublic health facilities are usually the first to receive interventions compared to private facilities, yet majority of health seeking care is first done with the latter. This study compared the capacity to manage acute febrile illnesses in children below 5 years in private vs public health facilities in order to design interventions to improve quality of care.MethodsA survey was conducted within 57 geographical areas (parishes), from August to October 2014 in Mukono district, central Uganda. The survey comprised both facility and health worker assessment. Data were collected on drug stocks, availability of treatment guidelines, diagnostic equipment, and knowledge in management of malaria, pneumonia and diarrhoea, using a structured questionnaire.ResultsA total of 53 public and 241 private health facilities participated in the study. While similar proportions of private and public health facilities stocked Coartem, the first-line anti-malarial drug, (98 vs 95%, p = 0.22), significantly more private than public health facilities stocked quinine (85 vs 53%, p < 0.01). Stocks of obsolete anti-malarial drugs, such as chloroquine, were reported in few public and private facilities (3.7 vs 12.5%, p = 0.06). Stocks of antibiotics-amoxycillin and gentamycin were similar in both sectors (≥90% for amoxicillin; ≥50 for gentamycin). Training in malaria was reported by 65% of public health facilities vs 56% in the private sector, p = 0.25), while, only 21% in the public facility and 12% in the private facilities, p = 0.11, reported receiving training in pneumonia. Only 55% of public facilities had microscopes. Malaria treatment guidelines were significantly lacking in the private sector, p = 0.01. Knowledge about first-line management of uncomplicated malaria, pneumonia and diarrhoea was significantly better in the public facilities compared to the private ones, though still sub-optimal.ConclusionDeficiencies of equipment, supplies and training exist even in public health facilities. In order to significantly improve the capacity to handle acute febrile illness among children under five, training in proper case management, availability of supplies and diagnostics need to be addressed in both sectors.

Highlights

Public health facilities are usually the first to receive interventions compared to private facilities, yet majority of health seeking care is first done with the latter
UNICEF, WHO and partners are working in an increasing number of countries to support the integrated community case management strategy to train, supply and supervise front-line workers to treat children for both diarrhoea and pneumonia, as well as for malaria in malaria-affected countries, using oral rehydration solution (ORS), zinc, oral antibiotics, and artemisinin-based combination therapy (ACT) [2]
Parishes were eligible for inclusion in the study if they: (1) contained a health centre II, the lowest public health facility where treatment is sought; (2) contained more than 200 households to ensure a sufficient number of patients visiting the drug shops; and, (3) contained at least one registered drug shop, a registered private clinic or a pharmacy by the National Drug Authority (NDA)

Summary

Introduction

Public health facilities are usually the first to receive interventions compared to private facilities, yet majority of health seeking care is first done with the latter. This study compared the capacity to manage acute febrile illnesses in children below 5 years in private vs public health facilities in order to design interventions to improve quality of care. Learning from the lessons experienced in the public sector roll out of integrated management of childhood illness (IMCI) [7, 8] and the iCCM at the community [9], we designed an a intervention to introduce iCCM among the private health providers (drug shops and private clinics). This study aimed to compare the private and public facilities in terms of capacity and appropriateness of care for acute febrile illnesses among children below five years in order to explore ways of improving quality of care

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Results

Discussion

Conclusion