REASONS WHY PATIENTS BYPASS LOWER LEVEL PUBLIC FACILITIES: A CROSS SECTIONAL STUDY FROM UGANDA [post]

2019 unpublished
The quality of services in Uganda at higher level health facilities are usually affected negatively by congestion when patients bypass care from their primary care health facilities (PCHF). The reason behind this bypass phenomenon in Uganda is limited. This study was conducted among patients receiving care at Lira Regional Referral Hospital in northern Uganda to identify reasons why patients bypass their PCHF. Methods We performed a descriptive cross-sectional study between 29/12/2014 &
more » ... 9/12/2014 & 30/1/2015, 484 respondents attending the outpatient department were recruited by systematic random sampling. Four focus group discussions (FGDs) each involving 10 participants were conducted. Quantitative data was collected using a validated questionnaire, entered, analysed by Epidata Entry 3.1 and SPSS 18 versions respectively. Descriptive statistics and chi square test for differences in the study population were used. For qualitative data, thematic analysis of transcripts was done. Codes and categories were developed and interrogated following an iterative process based on grounded theory. Results The majority (80.4%) of respondents (71.7% females, mean age 18-35 years, SD 0.85) bypassed their PCHF. Factors associated with bypass were: marital status, distance travelled of >10 km and tertiary education. FGDs reported lack of trust in the health care providers, lack of medicines and diagnostic equipment. Conclusions Poor quality of health services at PCHF encourages seeking care from higher-level facilities. Utilization of PCHF is limited due to poor infrastructure, shortage of medicines and human resource. Improvement of these issues will support PCHF which in turn can help reverse bypass phenomenon. Background The public health service delivery Uganda is structured into National Referral Hospitals (NRHs), Regional Referral Hospitals (RRHs), general hospitals and Health centres IV to I with health centre I 3 being a Village Health Team (VHT)[1]. Health centre II should be present in every parish serves about 5000 people and treat common diseases like malaria. It provides the first level of interaction between the formal health sector and communities, providing outpatient and antenatal care, community outreach services, and linkages with the VHTs. It is headed by an enrolled nurse supported by a mid-wife by running an outpatient department and offering antenatal care, two nursing assistants and one health assistant. Health centre III facility should be found in every sub county offering care to about 20,000 people. It is headed by a senior clinical officer supported by a laboratory technician and should have a functioning laboratory[2-4]. Health centre IVs and general hospitals have wards for men, women and children and admit patients. It should have a senior medical officer, other doctors, operating theatre for carrying out emergency operations and blood transfusions[5]. The Health centre IVs and general hospitals are referral units in a Health sub district. The health care service delivery is done through a decentralized framework in such a way that district health structure is responsible for all structures in the district except the Lira RRH. Despite the efforts by government of Uganda and development partners such as World Vision Uganda to increase the number of health facilities across the country so as to improve access to health care, many patients continue to bypass these facilities leading to patient congestion at Lira RRH. Several studies on bypass showed that participants in Africa and other parts of the world do not want to seek care at their nearest health centres regardless of their areas of residence [6][7][8][9][10][11][12][13]. A study from Pretoria, South Africa found that 69.4% bypassed the nearest health centre because of the long waiting time, long queues, rude staff, and absence of medication [14]. In Kenya, bypass was found among half or more mothers in a rural district attending provincial hospitals for antenatal care, child immunizations and other child health services. The reasons were poor care, lack of drugs and supplies, and poor laboratory services (12%) [10, 15, 16]. Other studies have shown that congestion at hospitals can be attributed to inappropriate referrals and to patients bypassing lower levels of healthcare opting to seek health services directly at higher-level facilities [9, 13, 17, 18]. Abbreviations PCHF: primary care health facilities, FGD: focus group discussion SPSS: statistical package for the social sciences SD: standard deviation KM: kilometer NRH: national referral hospital RRH: regional referral hospital 13 VHT: village health team OPD: outpatient department Declarations Ethical approval and consent to participate Ethical approval and clearance was obtained from the School of Medicine Research and Ethics Committee, Makerere University Kampala in Uganda (REC REF 2014-151) . A written informed consent was got from each participant before participating in the study. The participants were given all the necessary information concerning the study to assist them to make an informed consent. Confidentiality was ensured such that only the research team had access to the information given. Study code numbers were used to identify the questionnaires and no names were included on the questionnaires that also apply for the FGD. Those who declined consent had their choices respected with no prejudice or consequence. Participants were free to exit the study at any point they wished.
doi:10.21203/rs.2.12795/v1 fatcat:ono6pcoz4vb5pcvzrteses3hc4