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George Washington University

Publication Date

Fall 2008

Program Name

Uganda: Development Studies


Quality of health care is an important aspect of health services delivery because of its ability to maximize outputs within given resource constraints. Quality assurance programs for health care are paramount to the realization of good quality health care because of their ability to identify gaps in service provision. The Ministry of Health and other stakeholders in health care have created quality assurance supervision and support programs for the health sector, yet there is a disconnect between the programs and the operational realities of the sector. The health-related Millennium Development Goals (MDGs) are far from being achieved within Uganda and people are dying everyday from preventable and treatable diseases. Therefore, the research examined the issue of quality assurance from several angles: Government programming and provisions for quality assurance for health, private sector response to the issue of quality assurance, and community perceptions of and involvement in health care.

A variety of methodologies were used during the research including: literature review, key informant interviews, individual interviews, and participant observation. A review of government regulations, policies, and programs was essential to understanding the current situation regarding quality assurance programs for health care, whereas both key informant and individual interviews were used to supplement the theories behind the programs with actual information about their efficiency. Additionally, key informants shared critical information about the actual workings of the health sector, versus the image that is often portrayed to stakeholders and development partners. Finally, participant observation during the Health Sector’s Annual Joint Review Mission and a workshop for Senior Health Managers on Neglected Tropical Diseases (NTDs) allowed the researcher to assess the health sector’s commitment to quality assurance as well as observe and interact with key health policymakers.

The researcher found that there is, in fact, a wide gap between health sector policies and programs in theory and implementation. Although the Ministry of Health and other key stakeholders have excellent quality assurance programs in theory, they are not being operationally realized within the districts. The Yellow Star Program, consistently mentioned as one of key programs of the Quality Assurance Department of the Ministry of Health, is in actuality only fully implemented in a few districts, and only deals with issues of supervision, not improvement. Although development partners are beginning to fund programs related to this issue, there is an overall gap in private sector commitment to quality assurance policies and programs. There are Civil Society Organizations (CSOs) dealing with the issue of quality assurance; those that are working for health rights often do not have enough funding to make an impact nationally, and instead choose to focus their work in a few districts. Overall community perceptions of health care are low. Communities do not understand the level of quality health care they are entitled to, but also feel that current levels of health service delivery are inadequate. In summary, the quality of health care is still an under examined issue that needs to be resolved for the realization of the right to health and meaningful development within Uganda.


African Studies | Public Health


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