Immunization in Uganda's Private Hospitals and Private Health Clinics or Independent Healthcare Sub-sector (Private-for-Profit)
Immunization in Uganda's Private Hospitals and Private Health Clinics or Independent Healthcare Sub-sector (Private-for-Profit)
Strengthening
Involvement of Private Hospitals and Private Clinics (PFPs) in Routine
Immunization Activities in Uganda
Executive
Summary
The
main service provider for immunization in Uganda is the Public
Sector/Government Hospitals. However, utilization of private sector for
immunization is urgently needed as the private sector contributes more than 50%
in the delivery of health services in Uganda. Existing national immunization
data does not routinely include statistics on private sector (PFPs) immunization
delivery adequately.
Our
program objective was to strengthen immunization in private hospitals and
private clinics through sensitizing private sector players on how to engage
more in immunization activities. We have also carried out survey studies and
consultation workshops to find out the challenges faced by private health
sector in engaging more in immunization especially the Private–for Profit
Hospitals and clinics (PFPs).
Generally,
in recent years, provision of immunization services through the private sector
had slightly increased and needs to be supported to achieve national coverage
have targets and have impact on the communities they serve.
With
the growing demand for immunization, the role of private sector in immunization
is important as private hospitals and clinics are more evenly distributed than
public hospitals which are sparsely distributed.
Limited
information is available regarding the private sector utilization pattern in
immunization. Before, the contribution of the private sector in Uganda had not
been evaluated.
Private
Hospitals and clinics have been visited randomly in the five regions of the
country coupled with consultation workshops.
The
aim of the study tour was to strengthen the understanding, challenges regarding
immunization services in PFP’s and evaluate routine immunization in the private
hospitals and clinics.
During
the meetings with the private hospital operators, the team discussed key issue
affecting immunization coverage in the private sector and also explored the attitudes
and perspectives of private health professional on these issues.
The
issues discussed included private health professional view on immunization,
safety and storage of vaccines, data collection, record keepings, public –
private collaboration, government programs on communication and mobilization
for immunization in the private hospital sector.
Based
on discussions and studied of experiences, the following conclusions were made
by the team.
·
Safety
of vaccines and immunization.
Most
PFPs private hospitals/clinics are inadequately facilitated to keep and store
vaccines as some even didn’t have refrigeration facilities.
·
Technical
Perspective
All vaccines production/
provision are provided & certified by Government where some times
development partners (e.g. WHO, UNICEF) who support the procurement yet there
is little or in some areas no collaboration between PFPs and Government.
Ø Vaccines are
planned/produced based on country needs according to the MOH data and
information and there is not enough, organized information/data for PFP’s
hospitals and clinics.
Communication on immunization
programs.
Ø PFP’s Hospitals
and clinics are not involved in the planning stage to implementation and
evaluation of most of the immunization programmes.
Ø PFP’s should be
involved at all stages of diseases eradication and immunization service
programming to ensure full participation and commitment.
Ø PFPs should
articulate their own communication programme to effectively mobilize the
communities they serve to utilize immunization services.
The study established the
following to strengthen immunization in PFPs hospitals and clinics;
1.
Since
almost 50% of Uganda Health Service delivery is provided by the private Health
Sector therefore PFP’s can strategically serve as change agents that will
champion the cause of immunization and child health in Uganda.
2.
Most
PFPs are poor in record keeping and data management and many are not utilizing
the HMIS Systems provided by the MOH; further study and training is needed to
improve and determine how best to increase use of the HMIS in immunization
programmes. E.g. Provision of standard format/forms and software to PFPs.
3.
The
success of immunization programmes is dependent on broad participation of all
Health Service providers (public-private) and comprehensive enrollment of
people vaccinated.
4.
PFPs
Private Immunization providers should submit data to a centralized system or
regional registry.
5.
In
considering strategies to strengthen immunization in the PFPs hospital sector,
it is important to take into account both the barriers perceived by non
participants and the experiences of current participants.
6.
Utilization
of Private Sector (PFPs) Immunization services is low in Uganda.
7.
Communicate
best approaches and practices to PFPs hospitals and clinics.
8.
Develop
appropriate messages/communication on immunization addressing involvement of
PFPs hospitals and clinics. Help PFPs representative body develop immunization
task committees and working groups.
9.
Consolidate
involvement of PFPs in immunization programmes based on best practices from
other countries.
The objectives of the program
1.
Strengthen
the involvement of Private Hospitals and Private Clinics in Immunization
activities/programmes in Uganda.
2.
Ascertain
the contribution of PFPs hospitals to immunization coverage.
3.
Strengthen
PFPs undertaking of immunization.
4.
Share
experiences, and best practices on immunization programming among individual
PFPs clinics.
5.
Develop
a strategy that will champion and advocate for effective involvement of PFPs
immunization services.
The program was carried out in five regions of the
country.
There were consultations with individual PFPs
clinics and group consultation meeting/workshops.
Participants were owners/operators of PFP clinics, health
professionals, leaders, consultants and medical students.
Clinics visited and highlights of the meetings.
We met with operators of private clinics and health
professionals including pediatricians and public experts.
We discussed the current situation of immunization
in Uganda with specific reference to Private Health Sector involvement.
According to participants, the involvement of
private clinics has been low arising from poor mobilization, support and
organization of the PFP health sector.
This has in turn affected the coverage of immunization since they the PFP’s
clinics take a big portion of about 50% Health Service delivery in Uganda.
The involvement of PFPs in immunization programmes
varied from region to region apparently due to resources in a particular area
and sometimes the cultural misconceptions regarding immunization in that area.
It was also noted that PFP’s queried their
involvement in the immunization programs since most of them if not all operate on
a profit basis and immunization seems to be much of public health issue which
doesn’t yield profits from their clinics.
In spite of the very many immunization programs
PFP’s clinics and Hospitals are not involved in the planning and implementation
stages of immunization programs.
Private hospital regulation in Uganda has been
fragmented which makes it hard to collect and report data on immunization
statistics and role by PFP’s clinics.
It is important to clarify the perception that PFP’s
do not want to get involved immunization. These are false; most PFPs are
willing to participate in Immunization only that need to be supported both in
facilities and skills.
PFPs also queried the liability of a patient
vaccinated by a private provider i.e. in regard to any defect of the vaccines
or adverse drug effects of the vaccine on the patient. They wondered who takes
the liability in that case they are agents of the Government. (???)
It was also noted that most development partners
(e.g. UNICEF) and other international
organizations have a rigid policy of only dealing with government/MOH whereby a
program on immunization is only communicated through the government yet
sometimes on ground the government sees the private sector as its competitor
not as its partner as it normally alleges.
It was also noted that most people would immunize
through the private clinics and hospitals because they are easily accessible
and widely spread around the country.
Private sector (PFP’s) clinics involvement in
immunization can easily increase due to the public sector’s inefficiency,
inflexibility and lack of responsiveness to consumer demands.
Most of the private clinics / Hospital users
received their vaccines after having consulted pediatricians. It raises the
question in “whether it is for immunization or for the services of a specialist
that people seek services of private clinics/provider.
There is increasing health literacy among the
general population regarding the facilities needed for vaccine quality
maintenance. Private clinics and hospitals are more responsive to patient
demands but there is lack of expertise and facilities to deliver quality
immunization services.
Conclusion:
As the private hospitals/clinics involvement in
immunization is expected to increase, the government and other partners should
expand their immunization surveillance and services to the PFP’s health
sub-sector.
o
PFP’s
hospitals and clinics should be involved in development and implementation of
immunization programmes and communication strategies.
o
Interviews
revealed challenges faced when providing immunization services, inadequate
knowledge of vaccines, high cost of vaccines storage, inadequate vaccine supply
to PFP’s and lack of commitment from management.
o
Assessment
of immunization involvement and participation is highly relied on medical
records and poor PFPs involvement could be due to poor documentation - not
recording and keeping information in PFP’s health sector.
o
-
Privately owned PFP’s in Uganda are designed to provide care to the acutely ill
and have weak links with the community.
o
Facilities
should be supported to regularly keep and report on immunization services
outcomes.
o
Ministry
of Health (MOH) and its partners should establish mechanisms to ensure PFP’s
health workers are trained in keeping data to help assess immunization participation
and coverage by PFP’s. The design should incorporate continuous supportive
monitoring and supervision visits that stress commitment by management of
PFP’s.
o
Immunization
services in PFP’s health sector needs to be monitored and use PFP’s data to
inform country/National immunization polices and interventions.
o
The
infrastructure needed to monitor the performance of private health immunization
plans is inadequate.
o
Some
private health providers send patients to get vaccinations that should be
administered in the public care setting.
o
To
improve monitoring, private hospitals and clinics should collectively develop a
set of consistent measures.
o
In
some new districts vaccination coverage and immunization coverage remain
undetected which may provide a reservoir for future disease outbreaks.
o
It
was also noted that most private clinics deliberately have poor record keeping
disciplines and compliances for fear of being used by tax authorities and other
agencies.
o
Private
hospitals and clinics (PFP’s) immunization impact monitoring is a capacity
building opportunity which may be used to strengthen involvement of private
hospitals in surveillance and routine immunization activities in Uganda.
2010 UNAPH Report.
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