Abstract
ObjectiveAlthough the WHO-developed Service Availability and Readiness Assessment (SARA) tool is a comprehensive and widely applied survey of health facility preparedness, SARA data have not previously been used to model predictors of readiness. We sought to demonstrate that SARA data can be used to model availability of essential medicines for treating non-communicable diseases (EM-NCD).MethodsWe fit a Poisson regression model using 2013 SARA data from 196 Ugandan health facilities. The outcome was total number of different EM-NCD available. Basic amenities, equipment, region, health facility type, managing authority, NCD diagnostic capacity, and range of HIV services were tested as predictor variables.FindingsIn multivariate models, we found significant associations between EM-NCD availability and region, managing authority, facility type, and range of HIV services. For-profit facilities’ EM-NCD counts were 98% higher than public facilities (p < .001). General hospitals and referral health centers had 98% (p = .004) and 105% (p = .002) higher counts compared to primary health centers. Facilities in the North and East had significantly lower counts than those in the capital region (p = 0.015; p = 0.003). Offering HIV care was associated with 35% lower EM-NCD counts (p = 0.006). Offering HIV counseling and testing was associated with 57% higher counts (p = 0.048).ConclusionWe identified multiple within-country disparities in availability of EM-NCD in Uganda. Our findings can be used to identify gaps and guide distribution of limited resources. While the primary purpose of SARA is to assess and monitor health services readiness, we show that it can also be an important resource for answering complex research and policy questions requiring multivariate analysis.
Highlights
Background/RationaleThe World Health Organization (WHO) defines Essential Medicines (EM) as drugs considered critical to meeting the needs of the population and expects them to be accessible
We identified multiple within-country disparities in availability of EM used to treat noncommunicable diseases (EM-non-communicable diseases (NCD)) in Uganda
While the primary purpose of Service Availability and Readiness Assessment (SARA) is to assess and monitor health services readiness, we show that it can be an important resource for answering complex research and policy questions requiring multivariate analysis
Summary
The World Health Organization (WHO) defines Essential Medicines (EM) as drugs considered critical to meeting the needs of the population and expects them to be accessible. Drugs must be available and affordable.[1] Yet EM used to treat noncommunicable diseases (EM-NCD) remain poorly accessible to the populations of low- and middle-income countries (LMIC)[2,3,4,5], where non-communicable diseases (NCD) such as cardiovascular disease, diabetes, chronic lung disease, and mental health disorders are the leading causes of mortality. We sought to develop a scalable strategy for identifying within-country availability disparities from routinely collected data that could be compared across multiple LMIC. The WHO Service Availability and Readiness Assessment (SARA) is a widely endorsed methodology used to collect health facility-level data on essential medicines, technologies, and human resources. At the time of publication, 11 LMIC have conducted 17 SARA surveys.[10,11] Data from SARA surveys have been used in country reports and published articles, but these have relied solely on descriptive statistics.[12,13,14,15]
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