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.