FACTORS AFFECTING PROVISION OF ORAL HEALTH SERVICES IN MAGALE HC IV NAMISINDWA DISTRICT

TABLE OF CONTENTS

DECLARATION.......................................................................................................................................... i

DEDICATION............................................................................................................................................ iii

ACKNOWLEDGMENT ........................................................................................................................... iv

ABSTRACT................................................................................................................................................. v

TABLE OF CONTENTS ......................................................................................................................... vii

OPERATIONAL DEFINITION.............................................................................................................. xii

LIST OF TABLES....................................................................................................................................xiii

LIST OF FIGURES ..................................................................................................................................xiv

CHAPTER I ................................................................................................................................................1

1.0 INTRODUCTION.................................................................................................................................1

1.1 Background .......................................................................................................................................2

1.2 Problem Statement............................................................................................................................3

1.3 General Objective .............................................................................................................................4

1.4 Specific Objectives............................................................................................................................4

1.7 Conceptual Framework....................................................................................................................5

CHAPTER 2................................................................................................................................................6

2.0 LITERATURE REVIEW ....................................................................................................................6

2.1 Introduction.......................................................................................................................................6

2.2 Availability, Accessibility and Adequacy of OH Services.................................................................6

2.2.2 Evaluation of User’s satisfaction of OH services. ...........................................................................7

2.2.3 To determine how Political will influence provision of OH services..............................................7

CHAPTER 3................................................................................................................................................9

3.0 METHODOLOGY ...............................................................................................................................9

3.1 Study area............................................................................................................................................9

3.2 Sampling Procedure ............................................................................................................................9

3.3 Eligibility ............................................................................................................................................9

3.4 Study Variables.................................................................................................................................10

3.4.1 Objective 1: Availability, Accessibility and Adequacy of OH Services....................................10

3.4.2 Objective 2: Users’ satisfaction. ................................................................................................11

3.4.3 Objective 3: Political will ..........................................................................................................11

3.5 Data Management .............................................................................................................................11

3.5.1 Data collection: ..........................................................................................................................11

3.5.2 Data processing..........................................................................................................................11

3.5.3 Data analysis..............................................................................................................................12

3.5.4 Quality control ...........................................................................................................................12

3.5.5 Ethical considerations................................................................................................................12

3.5.6 Limitations of the study .............................................................................................................12

3.5.7 Dissemination of study findings ................................................................................................12

CHAPTER 4..............................................................................................................................................13

4.0 PRESENTATON OF RESULTS.......................................................................................................13

Table 1 Showing Participants Age Distribution..................................................................................13

Graph 1 Showing Participants Age Distribution.................................................................................13

Table 2 Showing sex distribution of the participants..........................................................................14

Chart 1 Showing sex distribution of the participants..........................................................................14

4.1 Accessibility......................................................................................................................................15

Table 2 showing physical barriers met by the patients.......................................................................15

Graph 2 showing physical barriers met by patients............................................................................15

Table 3 showing the average distance from the health centre to patients’ homes ..............................16

Chart 2 showing distance from patients’ home to health center .........................................................16

4.2 User Satisfaction ...........................................................................................................................17

Table 4 showing OH services user satisfaction...................................................................................17

Graph 3 showing OH services user satisfaction..................................................................................17

4.3 Political will..................................................................................................................................18

Table 5 showing Magale Health Center staffing.................................................................................18

Graph 4 showing Magale health center staff.......................................................................................18

Table 6 showing political will on OH service provision by District officials.....................................19

Chart 3 showing Political will on OH services...................................................................................19

CHAPTER 5..............................................................................................................................................20

DISCUSSION, CONCLUSION AND RECOMMENDATIONS..........................................................20

5.1 DISCUSSION......................................................................................................................................20

5.1.1 Availability, Accessibility and Adequacy of OH services.............................................................20

5.1.2 User satisfaction.............................................................................................................................21

5.1.3 Political will...................................................................................................................................21

5.2 CONCLUSION .............................................................................................................................22

5.3 RECOMMENDATION......................................................................................................................23

REFERENCES..........................................................................................................................................24

APPENDICES...........................................................................................................................................25

APPENDIX I ..........................................................................................................................................25

Questionnaire for exit (dental patients) interview...................................................................................25

APPENDIX II.........................................................................................................................................28

Questionnaire for OH personnel .............................................................................................................28

APPENDIX III........................................................................................................................................31

Questionnaire for PHC coordinators and medical superintendents ........................................................31

APPENDIX IV........................................................................................................................................33

Interview guide for members of the DHMC...........................................................................................33

APPENDIX V.........................................................................................................................................36

Health Facility Checklist.........................................................................................................................36

APPENDIX VI........................................................................................................................................39

Staff requirement per health care facility level in accordance with the National Oral Health Policy. ...39

APPENDIX VII ......................................................................................................................................43

District Map ............................................................................................................................................43

APPENDIX VIII.....................................................................................................................................44

Budget.....................................................................................................................................................44

ABSTRACT 

Oral diseases continue to rise yet the services are disintegrated mainly due to lack of resources. There are many factors that influence health and health care seeking. Although many of these factors are similar across populations, exactly how they interact and influence the actions of people The current study, a population-based cross sectional survey, identifies the users of OH services of a Health Centre IV and healthcare managers in a rural District of Uganda, to gain information regarding availability, accessibility and adequacy of OH services, evaluation of user satisfaction as well as determining the political will in the provision of OH services in the community .Participants of the survey were interviewed for personal information and details regarding the OH services received at the HC. Both qualitative and quantitative data were collected by use of interviewer-administered questionnaires, interview guides and check-lists. The respondents included 10 key informants and 82 patients attending dental clinics at Magale HC IV. The subsequent data was then analysed to determine which factors affected the provision of OH services within the study area and whether the study participants believed there is political will in improving the OH services by District healthcare managers. Barriers to respondents receiving OH services included physical access due to difficult mountainous terrain, distance and time taken to seek for OH services, 70% of the respondents stayed more than 5Km away from the HC. More so, inadequate staff and lack of dedicated budget to OH services. Despite this, 40% of the respondents were fairly satisfied with the services provided while 80% of the District healthcare managers believed there is political will on OH services provided. The level of staffing of OH personnel in Magale HC IV was inadequate, having only 1 dental nurse assistant and visiting dental surgeon, there was no designated space for an ideal dental clinic and lacks specific budget for OH services Furthermore, OH services were partly inaccessible due to physical barriers such as mountains, streams on their way to the health facility with more than 70% of the patients coming from communities more than 5 Km away from the health centre. User satisfaction is an important indicator of quality services. Overall, only 17.5% of the patients were very satisfied with the service. While 40% were fairly satisfied with the OH services provided, pointing out the major setbacks as insufficient communication with OH personnel, long waiting time and failure to access the OH personnel on time during emergencies. The well reported political will (80%) was mainly supported through the employment of visiting dental surgeon and provision of dental nurse vi assistant to the health facility. Based on the aforementioned findings, there was general inadequacy of resources for provision of OH services, poor accessibility due to difficult terrain and long distances from Magale HC IV as well as fair satisfaction on the care provision and significant political will for OH services in Namisindwa District. However, strengthening of community outreach service in the hard to reach areas, enhancing friendly approach to oral health education, employing more OH personnel and provision of required equipment instruments and supplies were recommended Furthermore, the hospital and district management should arrange and support supervision visits, staff appraisals, and communication and counseling sessions for the OH personnel while the planning committees consider reviewing and increasing the budget allocation with specific reference to Dental Unit.