Healthcare Evidence-Based Management: Towards Overcoming its Barriers in Uganda’s Local Government Healthcare System

Abstract

This article identifies local barriers and potential promoters of healthcare evidence-based management decision-making in Uganda's local government context. It puts to local context feasible measures for increasing research evidence utilization by healthcare decision-makers, as part of the efforts to make research more beneficial to intended users, and ultimate recipients of the services. The findings were a result of a cross-sectional semi-structured questionnaire survey of 225 clustered healthcare authorities 1 in Arua District Local Government, West Nile Sub-region of Uganda. The survey data were triangulated with nine key informant interviews (KIIs). Analysis reveals existence of multiple barriers at individual, organizational and system's levels of the local government healthcare management. Standing out prominently were barriers related to attitude, perceptions and beliefs of healthcare managers, dissemination, accessibility, communication, participation, engagement, capacity, knowledge, skills, cost, time, staffing, workload, leadership, policy enforcement, and culture. Other barriers related to researchers were their competence, authority and level of mutual trust. Fortunately, most of these barriers are consistent with those reported previously by other studies in developing countries. Through a critical logical analysis, recommended strategies for increasing utilization of research evidence were combined into five broad categories; stakeholders' engagement and participation, contextualized dissemination, capacity building, local leadership and democracy, and knowledge marketing, awareness and visibility. Again, these are not naïve, but important is the manner and details in which they have been contextualized. Hence, this article adds to existing knowledge about multifactorial contextual nature of barriers and promoters of research evidence utilization, and the importance of action research in providing evidence for improving quality of healthcare service delivery.