Okello D O, Lubanga R, Guwatudde D, Sebina-Zziwa A
Clinical Epidemiology Unit, Makerere Medical School, Kampala, Uganda.
Soc Sci Med. 1998 Jan;46(1):13-21. doi: 10.1016/s0277-9536(97)00130-5.
This paper presents the results of a health facility survey conducted in Uganda between June 1992 and December 1993. The survey covered both government and non-government organisation (NGO) facilities from 10 districts in the five regions of the country. The main objective of the survey was to assess resource use, costs and financing of health facilities. The survey found differences between resource levels of NGOs and government facilities. Government facilities were inadequately maintained, and mostly in a state of disrepair. The user fee scheme that had been recently introduced in some government units to meet running costs was not only inadequate, but was not being used to meet the needs of consumers. In addition, most available resources, including human resources, were concentrated in hospitals. As a result, there was heavy demand for hospital services and less use of services in the lower level facilities. And furthermore, staff in government facilities were paid much less than staff working for NGOs, who not only got better pay but also in-kind forms of rewards, which made them better motivated to work. The number of qualified staff, particularly for primary health care, was grossly inadequate, and most of the work in local facilities was being done by unqualified employees, such as ward maids and dressers. In order to alleviate some of the problems identified, particularly in government facilities, there is a need to explore ways in which more can be done with the available resources to improve the efficiency of health services. The user charge system could be effective in improving the resource base of the health facilities, but it must result in visible improvement in the quality of services for consumers to be willing to pay. Collection methods should be standardised, and expenditures supervised. As part of the government's decentralisation programme, districts should be given the power to recruit and fire personnel. Once this authority is in place, the district should consider employing fewer personnel at all levels and aim to pay them a living wage.
本文介绍了1992年6月至1993年12月在乌干达进行的一次卫生机构调查结果。该调查涵盖了该国五个地区10个区的政府和非政府组织（NGO）机构。调查的主要目的是评估卫生机构的资源使用、成本和融资情况。调查发现非政府组织和政府机构在资源水平上存在差异。政府机构维护不足，大多处于破败状态。一些政府单位最近为满足运营成本而引入的使用者付费计划不仅不足，而且并未用于满足消费者需求。此外，包括人力资源在内的大多数可用资源都集中在医院。结果，医院服务需求旺盛，而基层机构的服务使用较少。而且，政府机构的工作人员薪酬远低于非政府组织的工作人员，非政府组织工作人员不仅薪酬更高，还能获得实物奖励，这使他们工作积极性更高。合格工作人员数量严重不足，尤其是初级卫生保健方面，当地机构的大部分工作由不合格员工完成，如病房女仆和外科助手。为了缓解所发现的一些问题，特别是政府机构的问题，有必要探索如何利用现有资源做更多工作来提高卫生服务效率。使用者收费制度可能有助于改善卫生机构的资源基础，但必须使服务质量有明显改善，消费者才愿意付费。收费方式应标准化，支出应受到监督。作为政府权力下放计划的一部分，各区应被赋予招聘和解雇人员的权力。一旦获得这一权力，各区应考虑减少各级人员数量，并旨在支付给他们维持生计的工资。
