Regulation of Healthcare in Uganda
Denis (the Project Coordinator for Salem) took me to the District Offices in Mbale this morning. I asked him to arrange and introduction for me in an attempt to understand their inspection system. The building and the set up reminded me of the Temple of Peace in Cathays when it was Bro Taf Health Authority; not because they are exactly the same but there are many similarities. The district office is a single story building with several offices to either side of the board room/library. The District Health Officer is a public health doctor. I spoke at some length with the public health nurse who does a lot of in service training for health workers and is also involved in the ‘inspections’. If I have understood it correctly inspections here are not known as such, they are visits linked to the supervision framework.
The supervision framework set out by the Ministry of Health (MoH) describes how the MoH provides supervision to the district in the way that they perform their functions. In turn the district health officials provide supervision to the clinicians in the health care providers in their performance in delivering healthcare services. When an ‘inspection’ takes place there is a visit by quite a large team of people with varying expertise and the district health officials who undertake the supervision. They identify areas of commendations and areas for improvement and then sit down and discus with the healthcare provider how they can put together a plan to address areas for action.
The framework against which performance is monitored is derived from policy and standards documents issued by the MoH. Rather than having cross cutting standards which are relevant to all areas these have been produced in relation to work streams and funding i.e. malaria treatment, injection safety and waste management, TB & HIV management, prevention of mother to child transmission of HIV, anaemia, rabies surveillance, reproductive health and education for parents on sexuality and HIV/AIDS prevention. This means that policies are focussed on these areas rather than on generic factors such as infection control, record keeping, risk management etc etc.
I explained the 3 tier approach (patient experience, organisational, board) to inspection in Wales to the District Health Officer who was very keen to explore ways that they could use this, recognising that board members generally know very little about the performance of organisations and the need for better information at this level to inform decision making. He seemed to think I might be coming back at a later date to do some more work with him on this – I explained that is a debate to be had at another level!!
I have lots of work to do back at base now that I understand a bit better how the system works and what is meant to be in place.
Feeling grotty
I’ve got a horrible cold at the moment. It started 2 days ago and my nose is just pouring. The worst bit is the sneezing and when it runs down the back of your throat and makes you feel sick. Ugggg. Still it should be better in a few days. It was interesting last night as I was on my over to the new path lab with the head of the lab to do a monitoring site visit – as work is progressing very well. I said not to come too close as I was ‘full of germs’; his response was ‘yes but its self limiting’. Even though I was feeling a bit sorry for myself it made me think of the other diseases around here that are dealt with on a daily basis and are much worse and put it in a perspective which made me feel quite selfish I suppose.
Update on the local brew
I gave you a description previously of the beer brewed in the local villages but had trouble with the images taken by one of my housemates. I have copied the text from before but added in the images as I have managed to save them now – I think you’ll see what I mean.
We haven’t been back for any more even though we had a few offers....
The beer story with pictures -
One of the staff here who lives on site said that he had to go back to his home town on Friday and promised to bring back some of the local beer that is brewed in the villages for us to try. When he returned he invited us all over for a taste. This sounded great so off we trotted to next door for a sample. ‘We’ is Misha and Sarah (my German housemates) and I.
The local beer is brewed from millet, a very small hard grain. The brew is ready to drink after about 7 days of fermenting. We were advised that it can be taken with either hot water or cold water, but that people who drank it with cold water get drunk very quickly.
The beer is poured from a large canister into a clay pot and this is topped up with either the hot or cold water – we all opted for hot.
Each person is then supplied with a very long drinking straw. The ones we had were about 4 – 5 feet in length, so that you can sit in your chair and sip the beer from the pot. The end of the straw is covered in a tea bag like filter so that the solids in the bottom of the pot don’t get sucked up into the straw. Traditionally the mouth piece is made from a turkey quill, but the ones we had were made from plastic (I think).
The beer was not quite what I was expecting a beer to look like. It was thick grey brown liquid (a bit like cement) and had a slightly chocolaty, gritty, sharp flavour. We did not really drink very much and I hope we didn’t offend our host but it was very different to what we are used to as a beer.
Our host told us that back in the villages, when a person has had enough to drink, they are not expected to say anything but to quietly remove themselves and go off on their way. He said they often look around and wonder where people have gone. He also said that once the brew has been drunk the millet in the bottom is eaten in areas where they are short of food.
We have had offers to go over and finish the container for the last couple of nights but have very politely declined. I wonder if they really like it that much – they seem very keen to give it away!
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