Juliet Mwanga-Amumpaire: Private health facilities need support to improve
Juliet Mwanga-Amumpaire is a paediatrician and Associate Professor of paediatrics at Mbarara University with over ten years of experience conducting clinical research. She is currently the director of Epicentre Mbarara Research Centre run by Médecins Sans Frontières that conducts health related research aiming to guide policy for stakeholders in health. She recently pursued her PhD where she studied the quality of care at private health facilities in Uganda.
Associate Professor Juliet Mwanga-Amumpaire recently pursued her doctoral degree through a collaboration between Makerere University in Uganda and Karolinska Institutet, an opportunity she describes as feeling fortunate to have had. With the guidance and support from her supervisors at Makerere University Professor Grace Ndeezi and Associate Professor Joan Nakayaga Kalyaango and at KI Professor Tobias Alfvén and Associate Professor Karin Källander, she successfully defended her thesis last fall and graduated from her doctoral studies in February 2023.
Structure of Uganda’s healthcare system
The health care system in Uganda is pluralistic in the sense that it is both private and public. The public health sector has health facilities at district, regional and national level, ranging from health centres to district and national referral hospitals. Similarly, the private health sector has hospitals and smaller health clinics, that can either be private for profit or private not for profit which are mainly run by NGOs or religious based health facilities. Among the private health providers, are also traditional healers which is common in Uganda.
"All these facilities, private and public, should be regulated and supervised by the Ministry of Health through different regulatory bodies. But we find that this is not the case for the private sector which causes problems", says Mwanga-Amumpaire.
The role of the private sector in diagnostics and treatment of infectious diseases
In Uganda, the private facilities are accessible since most are small and can easily be placed everywhere including rural areas. Because of their availability, most people first visit a private health centre before visiting public hospitals or other facilities.
"It is said that up to 70% of people go to private facilities, and 50-60% of children first seek care in private facilities before either being referred to public hospitals or going there on their own in case their course of disease has gotten worse despite the medical treatment they receive. However, up to 50-70% will get care entirely from private facilities", says Mwanga-Amumpaire.
Capacity of private health clinics
The capacity of the private care depends on the level, Mwanga-Amumpaire explains. Bigger hospitals have medical doctors and other healthcare workers, infrastructure, and financial support. However, most people visit lower level health facilities that are smaller with a limited number of health workers, often only one nurse and no doctor or lab.
"Some of them are even run by a provider who may have never had been medically trained and it is of course dangerous. This is more common in rural areas where supervision is rare.
Several lower level facilities do not have enough health workers and in some instances the health workers are often not qualified enough ordo not have sufficient current knowledge to treat especially children, or young clinicians that recently graduated and have not been supervised in hospitals".
The diagnostic facilities are rare in smaller clinics in rural areas and lack equipment, labs and qualified health workers that can perform tests. The results of diagnostics test are not reliable as the testing procedures are not standardized, do not follow standard operating procedures and often use expired reagents.
For simple and uncomplicated illnesses, the private facilities have medicines to prescribe. The problem is how these are prescribed, more specifically health workers overprescribe medicines.
Perspectives of healthcare workers and policymakers
"Policymakers acknowledge that lower level health private facilities are not doing as well as they should. The main reason for that is because the lack of capacity both in staff and resources. But also, they are not receiving enough supervision and support", says Mwanga-Amumpaire.
She explains that private health care workers know that the Ministry of Health provide support and trainings but only to the public health care which are run by the government. This has left lower level private healthcare workers to feeling left out and unsupported.
Digital solutions to reach all health care providers
Private health clinics are important in providing health care. Juliet Mwanga-Amumpaire argues that if Uganda is to move along with the rest of the world and achieve universal health coverage it is important that private facilities are also supported to provide quality care.
"From our findings we recommend that guidelines and trainings from the Ministry of Health should reach all health care providers including private facilities. We think that the Ministry of Health together with other stakeholders involved in supervising should be more supportive".
She suggests making use of innovative digital solutions to provide support and trainings online when lack of resources makes it difficult to reach everyone in person. For future research it needs to be investigated if it is feasible in Uganda to provide online training.
"It is key to improve quality and it is something that can be done, why? Because most of the causes of death are preventable anyways. I think if we put in some effort and do the small things we can such as mobilising resources, work together and build partnerships, the healthcare can be improved".