Costs and coverage of reproductive health interventions in three rural refugee‐affected districts, Uganda

Abstract

Summarybackground Uganda has hosted an estimated 200 000 refugees in post-emergency phase settlements interspersed within host communities since 1990. However, refugee health service runs parallel to host in most refugee-affected districts. The process of integration of health services began in 1999.objective To estimate and compare the costs and coverage of reproductive health (RH) interventions in refugee and host populations in three rural West Nile refugee-affected districts of Uganda.methods Data on costs of RH interventions were collected through a survey in 38/116 (33%) health facilities (3 public hospitals and 35 health centres). Data on coverage of RH interventions were collected from all 116 health facilities in the three rural refugee-affected districts for 2 years, 2003 and 2004.results The costs and coverage of RH interventions significantly varied between population categories and among levels of refugee and host health facilities. Per capita cost of health care is 2.7 times higher for the refugee than the host population (US$13.12 vs. US$4.85 1 ). The cost per RH intervention is higher in the refugee than in the host health system (US$3.02 vs. US$2.73). Significantly more refugees attend antenatal care [99.4% (95% CI, 97.5-100) vs. 53.5% (53.22-53.78); P < 0.0001]. The proportion of births in health facilities was significantly greater among refugees [37.3% (36.12-38.48) vs. 15.2% (15.01-15.39); P < 0.05]. Major obstetrical interventions for absolute maternal indications were significantly more frequent among refugees than the host population living in the same region [1.02% (0.79-1.25) vs. 0.85% (0.80-0.90); P < 0.05].conclusions Our study has shown higher costs and coverage in refugee than host health services. The findings suggest policy recommendations for improving the capacity, financing, organization and the performance of host health system in the refugee-affected settings.

Risk Factors For Perinatal Mortality In Arua Regional Referral Hospital, West Nile, Uganda

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Access to maternal and perinatal health services: lessons from successful and less successful examples of improving access to safe delivery and care of the newborn

“…On the whole, the per capita cost of health care was 2.7 times higher for the refugee than the host population (US$13.12 vs. US$4.85), mainly because refugee health services are run by staff of higher professional qualifications and because drugs, materials and supplies are more readily available, prescribed and used in refugee (Orach et al. 2007).…”

War and Gender Inequalities in Health: The Impact of Armed Conflict on Fertility and Maternal Mortality

“…Among three rural refugee-affected districts in Uganda, Orach et al (23) found that the per capita cost of health care and cost per reproductive health intervention was substantially higher for the refugees than the host population. Additionally, the proportion of refugees who attended ANC, gave birth in health facilities, and undertook major obstetric interventions were equally significantly greater compared to the host population.…”