Main findings Health facility profiles T
he delivery of facility-based health services
fewer services and were more specialized than referral and
ranging from personnel to physical infrastruc-
among referral hospitals, district hospitals, and health centers
requires a complex combination of resources,
district hospitals. HIV/AIDS services were largely available
ture, that vary in their relative importance
(72%), but a lower proportion of private hospitals (59%) and
and cost to facilities. Determining what factors support the
clinics (20%) reported providing HIV/AIDS care.
efficiency at health facilities is critical information to policy-
health centers showed a fairly high availability of prior-
to expand health system coverage and functions within
of health services in Uganda (MOH et al. 2012, Okwero et
provision of services at lower costs and higher levels of
In general, referral hospitals, district hospitals, and
makers, especially as countries like Uganda consider how
ity services that are considered part of a basic package
constrained budgets.
al. 2011), including a formal immunization program (94%),
analyzed five key drivers of health service provision at fa-
accordance with the country’s plan to expand maternal
Using the ABCE Uganda facility sample (Table 6), we
antenatal care (ANC) (85%), and family planning (83%). In
cilities:
and child services to lower levels of care (MOH 2010a), we
found that 37% of health center IIs provided routine deliv-
• Facility-based resources (e.g., human resources, infra-
ery services. A goal in the Uganda Health Sector Strategic
structure and equipment, and pharmaceuticals), which
Plan III (HSSP III), 2010/11–2014/15 was to introduce deliver-
are often referred to as facility inputs.
ies to health center IIs (MOH 2010a), and we found that a
• Patient volumes and services provided at facilities (e.g.,
subset of this platform offered such services two years later.
outpatient visits, inpatient bed-days), which are also
However, progress in service availability was not uniform
known as facility outputs.
across platforms. The previous health sector plan stipulated
that 100% of regional referral hospitals should have func-
• Patient-reported experiences and their reported costs
tional accident and emergency units by 2010, but based
of care, capturing “demand-side” factors of health ser-
on the ABCE sample, fewer than 80% of referral hospitals,
vice delivery.
including both national and regional hospitals, reported
• Facility alignment of resources and service production,
having emergency services in 2012. In the ABCE sample,
which reflects efficiency.
three referral hospitals lacked an accident emergency unit.
Availability of emergency services declined in parallel with
• Facility expenditures and production costs for service
descending levels of care in the public sector, with 73%
delivery.
of district hospitals, 42% of health center IVs, and 28% of
These components build upon each other to create
health center IIIs offering emergency services. Fewer than
a comprehensive understanding of health facilities in
a quarter of private hospitals featured an emergency unit.
Uganda, highlighting areas of high performance and areas
Differences in service availability across platforms were
for improvement.
not unexpected, as the Ugandan health system is deliber-
ately structured to have varying levels of care, from referral
Facility capacity and characteristics
hospitals to health center IIs (MOH 2010a). This is particularly
relevant for lower levels of care, as few, if any, health centers
Service availability
IIIs or health center IIs are supposed to offer more special-
Across and within platforms in Uganda (Figure 3), several
ized services such as chemotherapy or admit inpatients. As
notable findings emerged for facility-based health service
a result, a finding that less than 5% of these facilities offer
provision. Referral and district hospitals reported providing
such services is not necessarily cause for concern.
a wide range of services, including surgical services, internal
At the same time, substantial variation was found
medicine, and specialty services such as emergency obstetric
within facility types, reflecting potential gaps in achieving
care and tuberculosis care. Private hospitals generally offered
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